Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | 138794 | NY |
NPI | 1043299894 |
---|---|
Provider Name | Dial Hewlett |
First Address | Bronx, NY 10461-2300 |
Second Address | Bronx, NY 10461-2300 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2006 |
Last Update Date | 10/07/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00797264 | (05) | NY |
B17386 | (02) |