Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 147545 | NY |
NPI | 1003835000 |
---|---|
Provider Name | Anukware Ketosugbo |
First Address | New York, NY 10087-5619 |
Second Address | Brooklyn, NY 11238-4955 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 19/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01036039 | (05) | NY |
B80340 | (02) |