Individual
STEVENSON DERODAR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
765 RIVERSIDE DR, NEW YORK, NY 10032-7358
(718) 377-5000
Mailing address
765 RIVERSIDE DR, NEW YORK, NY 10032-7358
(718) 377-5000
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
008240
NY
Other
Enumeration date
03/16/2022
Last updated
03/16/2022
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