Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 240757 | NY |
NPI | 1013176387 |
---|---|
Provider Name | Brendon Matthew Stiles |
First Address | New York, NY 10065-4885 |
Second Address | New York, NY 10065-4870 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2008 |
Last Update Date | 09/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0167592 | (05) | NJ |