Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 032011-1 | NY |
NPI | 1083999312 |
---|---|
Provider Name | Taly Gofer |
First Address | Brooklyn, NY 11237-3489 |
Second Address | Brooklyn, NY 11237-3489 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2011 |
Last Update Date | 18/10/2011 |