Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | 251905 | NY |
NPI | 1013129816 |
---|---|
Provider Name | Andrew S Bomback |
First Address | New York, NY 10032-3720 |
Second Address | New York, NY 10032-3720 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2007 |
Last Update Date | 24/08/2011 |