Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2084N0400X | Neurologist | 14967 | NH |
Y | 2084N0600X | Clinical Neurophysiologist | 14967 | NH |
NPI | 1003903188 |
---|---|
Provider Name | Dr. Erik J. Kobylarz |
First Address | Lebanon, NH 03756-0001 |
Second Address | Lebanon, NH 03756-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/10/2006 |
Last Update Date | 14/10/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02276933 | (05) | NY |
1017924 | (05) | VT |
30209789 | (05) | NH |
H68234 | (02) |