Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | N004074 | NY |
NPI | 1407919673 |
---|---|
Provider Name | Dr. Frank Dittmar |
First Address | West Babylon, NY 11704-6003 |
Second Address | West Babylon, NY 11704-6003 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2006 |
Last Update Date | 24/01/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T51388 | (02) |