Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 058611 | NY |
NPI | 1033476601 |
---|---|
Provider Name | Boris Gefon |
First Address | Brooklyn, NY 11229-3906 |
Second Address | Brooklyn, NY 11229-3906 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2012 |
Last Update Date | 17/08/2016 |