Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204F00000X | Transplant Surgeon | 0024381 | NY |
Y | 2086S0120X | Pediatric Surgery | 250182 | NY |
NPI | 1790726982 |
---|---|
Provider Name | Dr. Dominique M. Jan |
First Address | Bronx, NY 10467-2801 |
Second Address | Bronx, NY 10467-2801 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2006 |
Last Update Date | 19/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02729091 | (05) | NY |
I48328 | (02) | NY |