Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 053109 | NY |
NPI | 1043544117 |
---|---|
Provider Name | Dr. Alex G Pappas |
First Address | Franklin Square, NY 11010-1222 |
Second Address | Franklin Square, NY 11010-1222 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2009 |
Last Update Date | 23/09/2009 |