Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 016663 | NY |
N | 2251P0200X | Physical Therapist - Pediatrics | 016663 | NY |
N | 2251S0007X | Physical Therapist - Sports | 016663 | NY |
N | 2251X0800X | Physical Therapist - Orthopedic | 016663 | NY |
NPI | 1063497717 |
---|---|
Provider Name | Mr. Stephen Michael Joseph |
First Address | Holbrook, NY 11741-4616 |
Second Address | Holbrook, NY 11741-4616 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2005 |
Last Update Date | 08/03/2021 |