Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | 299053 | NY |
NPI | 1760845432 |
---|---|
Provider Name | Adam Shore |
First Address | Brooklyn, NY 11230-5778 |
Second Address | Brooklyn, NY 11203-2054 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2016 |
Last Update Date | 03/11/2021 |