Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 009358 | NY |
NPI | 1013410968 |
---|---|
Provider Name | Mr. Sivaswamy Ramachandran |
First Address | Brooklyn, NY 11231-4715 |
Second Address | Staten Island, NY 10310-1906 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2018 |
Last Update Date | 16/03/2018 |