Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 208709 | NY |
NPI | 1356423826 |
---|---|
Provider Name | Dr. Douglas Weston |
First Address | Brooklyn, NY 11229-2501 |
Second Address | Brooklyn, NY 11223-3802 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01818148 | (05) | NY |
G62995 | (02) |