Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | TR001614 | NJ |
Y | 225XH1200X | Occupational Therapist - Hand | 9511000027 | NJ |
NPI | 1275654667 |
---|---|
Provider Name | Shirish R Godbole |
First Address | Old Bridge, NJ 08857 |
Second Address | Old Bridge, NJ 08857 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2007 |
Last Update Date | 13/09/2012 |