Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 303650 | NY |
Y | 213ES0000X | Sports Medicine | 303650 | NY |
NPI | 1245619022 |
---|---|
Provider Name | Andrew Beaufort |
First Address | Hoboken, NJ 07030-3808 |
Second Address | New York, NY 10029-6528 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2015 |
Last Update Date | 10/08/2020 |