Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 097040 | NY |
NPI | 1003825258 |
---|---|
Provider Name | Allen Steven Laub |
First Address | Garnerville, NY 10923-1552 |
Second Address | Garnerville, NY 10923-1552 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00417854 | (05) | NY |
B17244 | (02) |