Individual
MR. GEORGE JAKE CANAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OCCUP. THERAPIST
Contact information
Practice address
1401 CHRISTINE RD, MOHEGAN LAKE, NY 10547-1774
(646) 339-4439
Mailing address
1401 CHRISTINE RD, MOHEGAN LAKE, NY 10547-1774
(646) 339-4439
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
006932
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
931767939
UNITED FEDERATION OF TEACHERS
NY
Enumeration date
09/20/2010
Last updated
09/20/2010
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