Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 036671 | NY |
NPI | 1003228834 |
---|---|
Provider Name | Pooja Mehta |
First Address | Irvington, NY 10533-1543 |
Second Address | Irvington, NY 10533-1543 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2014 |
Last Update Date | 28/05/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Q6W8B1 | (02) | NY |