Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 049622 | NY |
NPI | 1083762363 |
---|---|
Provider Name | Dr. Evan Ashley Lynn |
First Address | New York, NY 10016-2651 |
Second Address | Melville, NY 11747-3007 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/01/2007 |
Last Update Date | 08/07/2007 |