Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 040050-1 | NY |
NPI | 1114139219 |
---|---|
Provider Name | Dr. Brian Chadroff |
First Address | Rego Park, NY 11374-1149 |
Second Address | Rego Park, NY 11374-1149 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2007 |
Last Update Date | 08/07/2007 |