Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 220676 | NY |
NPI | 1295886612 |
---|---|
Provider Name | Dr. Dmitry Konstantinovich Nesen |
First Address | Mamaroneck, NY 10543-1115 |
Second Address | New York, NY 10021-3150 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/01/2007 |
Last Update Date | 29/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H51415 | (02) |