Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 232236 | NY |
NPI | 1023037934 |
---|---|
Provider Name | Dr. Cheng H Lo |
First Address | Stony Brook, NY 11790 |
Second Address | Stony Brook, NY 11794 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02574005 | (05) | NY |
1N0241 | EMPIRE BC.BS (01) | NY |
7187629 | AETNA (01) | NY |
I14116 | (02) | NY |