Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 002339 | NY |
NPI | 1497895700 |
---|---|
Provider Name | Dr. Bruce Michael Rodin |
First Address | New City, NY 10956-5200 |
Second Address | New City, NY 10956-5200 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T50726 | (02) | NY |