Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YP0228X | Pediatric Otolaryngology | A 133118 | CA |
NPI | 1952546384 |
---|---|
Provider Name | David Conrad |
First Address | New York, NY 10128-3416 |
Second Address | New York, NY 10003 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2008 |
Last Update Date | 24/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
26050 | STUDENT (RESIDENT) (01) | NY |