Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 40QA01417900 | NJ |
NPI | 1033564117 |
---|---|
Provider Name | Ms. Suzanne Goodman |
First Address | Wyckoff, NJ 07481-1438 |
Second Address | Montclair, NJ 07042-3451 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2016 |
Last Update Date | 26/04/2016 |