Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | N005204 | NY |
Y | 222Z00000X | Podiatrist | N005204 | NY |
NPI | 1013123025 |
---|---|
Provider Name | Dr. Devan Neal Lax |
First Address | Brooklyn, NY 11201 |
Second Address | Yonkers, NY 10705 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U59957 | (02) |