Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | 167788 | NY |
NPI | 1215997531 |
---|---|
Provider Name | Dr. Alan Ross |
First Address | Bronx, NY 10469-5947 |
Second Address | Bronx, NY 10469-5947 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2006 |
Last Update Date | 30/03/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01517064 | (05) | NY |
D67689 | (02) | NY |