Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | N004210 | NY |
NPI | 1184767055 |
---|---|
Provider Name | Dr. Craig Brandoff |
First Address | New York, NY 10004-1617 |
Second Address | New York, NY 10004-1617 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T51406 | (02) | NY |