Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 210190 | NY |
NPI | 1477584977 |
---|---|
Provider Name | Craig Title |
First Address | New York, NY 10019-3211 |
Second Address | New York, NY 10019-3211 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2006 |
Last Update Date | 18/04/2008 |