Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 229148 | NY |
NPI | 1053481978 |
---|---|
Provider Name | Alan Derzie |
First Address | New York, NY 10087-9580 |
Second Address | Brooklyn, NY 11219-2916 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02522961 | (05) | NY |
I00370 | (02) | NY |