Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | ||
Y | 2251G0304X | Physical Therapist - Geriatrics | 40QA003097 | NJ |
NPI | 1295047041 |
---|---|
Provider Name | Phyllis Flancbaum |
First Address | Fair Lawn, NJ 07410-4946 |
Second Address | Emerson, NJ 07630-1828 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2010 |
Last Update Date | 09/07/2010 |