Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter | ||
N | 225CA2400X | Assistive Technology Practitioner |
NPI | 1124437975 |
---|---|
Provider Name | Valerie Pagan |
First Address | Rutherford, NJ 07070 |
Second Address | Rutherford, NJ 07070 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/08/2014 |
Last Update Date | 06/08/2014 |