Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 040110 | NY |
NPI | 1114060753 |
---|---|
Provider Name | Dr. Eric A Wachs |
First Address | Tarrytown, NY 10591-4500 |
Second Address | Tarrytown, NY 10591-4500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U12309 | (02) | NY |