Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207ND0101X | MOHS-Micrographic Surgeon | 262834 | NY |
N | 207NS0135X | Procedural Dermatology | 262834 | NY |
NPI | 1306972120 |
---|---|
Provider Name | Andreas Boker |
First Address | New York, NY 10036-7902 |
Second Address | New York, NY 10036-7902 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2007 |
Last Update Date | 09/11/2011 |