Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 152816 | NY |
NPI | 1023135100 |
---|---|
Provider Name | Ben O Umeze |
First Address | Bronx, NY 10462-4919 |
Second Address | Bronx, NY 10462-4919 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2007 |
Last Update Date | 08/09/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00928074 | (05) | NY |
B17104 | (02) |