Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 230346 | NY |
NPI | 1053397661 |
---|---|
Provider Name | Bertrand D Guillonneau |
First Address | New York, NY 10017-6706 |
Second Address | New York, NY 10021-6007 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/12/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H76799 | (02) |