Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 040859 | NY |
NPI | 1124118880 |
---|---|
Provider Name | Dr. Erich George Wunsch |
First Address | Brooklyn, NY 11209 |
Second Address | Brooklyn, NY 11209 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2006 |
Last Update Date | 11/02/2014 |