Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251X0800X | Physical Therapist - Orthopedic | 016093 | NY |
Y | 2251X0800X | Physical Therapist - Orthopedic | 40QA00673300 | NJ |
NPI | 1043217649 |
---|---|
Provider Name | Wendy Haberman-Johnson |
First Address | Mahwah, NJ 07430-0485 |
Second Address | Mahwah, NJ 07430-3613 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2005 |
Last Update Date | 17/04/2013 |