Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | X013383 | NY |
NPI | 1003414079 |
---|---|
Provider Name | Dr. Brett John Poniros |
First Address | Pleasantville, NY 10570-3146 |
Second Address | Pleasantville, NY 10570-3146 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2020 |
Last Update Date | 13/10/2020 |