Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 46TR00724200 | NJ |
NPI | 1669838744 |
---|---|
Provider Name | Mr. Simon Levin |
First Address | Garfield, NJ 07026-1827 |
Second Address | Garfield, NJ 07026-1827 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/01/2016 |
Last Update Date | 02/02/2020 |