Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | X008787-1 | NY |
NPI | 1568434389 |
---|---|
Provider Name | Dr. Brian Keith Mungeer |
First Address | Ferndale, NY 12734-4315 |
Second Address | Ferndale, NY 12734-4315 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
V07991 | (02) | NY |