Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | MT199412 | PA |
Y | 208600000X | Surgeon | MT199412 | PA |
NPI | 1003100025 |
---|---|
Provider Name | Dr. Allan Marc Conway |
First Address | New York, NY 10075-0969 |
Second Address | New York, NY 10075-0969 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2011 |
Last Update Date | 14/06/2012 |