Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | 028142 | NY |
NPI | 1245548411 |
---|---|
Provider Name | Mr. Ronald Fabello |
First Address | Hicksville, NY 11801-4036 |
Second Address | New York, NY 10031-1716 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2010 |
Last Update Date | 16/10/2020 |