Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 024948 | NY |
NPI | 1093084154 |
---|---|
Provider Name | Mr. Ronald Franz Restivo |
First Address | Port Washington, NY 11050-2708 |
Second Address | Port Washington, NY 11050-2708 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2011 |
Last Update Date | 19/12/2011 |