Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 253920 | NY |
NPI | 1205945409 |
---|---|
Provider Name | Dr. Friedrich Boettner |
First Address | New York, NY 10021-4872 |
Second Address | New York, NY 10021-4872 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 20/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I67955 | (02) | NY |