Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 46TR00158500 | NJ |
NPI | 1033444559 |
---|---|
Provider Name | Shifra K Leiser |
First Address | Passaic, NJ 07055-3415 |
Second Address | Newark, NJ 07107-3001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2009 |
Last Update Date | 16/10/2009 |