Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2082S0105X | Plastic Hand Surgeon | 086537 | NY |
NPI | 1699874321 |
---|---|
Provider Name | Carlos C. Bazan |
First Address | New Hyde Park, NY 11040-1429 |
Second Address | New Hyde Park, NY 11040-1429 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2006 |
Last Update Date | 13/11/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03335 | MEDICARE PTAN (01) | NY |
B10809 | (02) | NY |