Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207U00000X | Nuclear Medicine Specialist | 194637-1 | NY |
NPI | 1003892613 |
---|---|
Provider Name | Borys Krynyckyi |
First Address | Manasquan, NJ 08736-1529 |
Second Address | Wall, NJ 07719-3706 |
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 |
---|---|---|
01787053 | (05) | NY |
G60511 | (02) | NY |