Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 190271 | NY |
NPI | 1508942046 |
---|---|
Provider Name | Aric Hausknecht |
First Address | New York, NY 10016-3005 |
Second Address | New York, NY 10016-3005 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2006 |
Last Update Date | 04/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01689216 | (05) | NY |
G03718 | (02) | NY |