Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 014679-1 | NY |
NPI | 1275796146 |
---|---|
Provider Name | Mr. Stuart Ehrenberg |
First Address | Brooklyn, NY 11215-5406 |
Second Address | Brooklyn, NY 11215-5406 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2008 |
Last Update Date | 09/07/2008 |