Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | 293324-1 | NY |
NPI | 1124394234 |
---|---|
Provider Name | David Phillips |
First Address | New York, NY 10021-5663 |
Second Address | New York, NY 10021 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2012 |
Last Update Date | 16/05/2018 |