Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 185504 | NY |
NPI | 1023104676 |
---|---|
Provider Name | Avijit D Mukerji |
First Address | Staten Island, NY 10314-2364 |
Second Address | Staten Island, NY 10314-2364 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 05/09/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F18838 | (02) |