Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 134130 | NY |
NPI | 1083632905 |
---|---|
Provider Name | Dr. Dennis Lyle Draizin |
First Address | Rockville Centre, NY 11570-3814 |
Second Address | Rockville Centre, NY 11570-3814 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00774956 | (05) | NY |
C01899 | (02) |