Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 269641-1 | NY |
NPI | 1548469091 |
---|---|
Provider Name | Dr. George Andrew Poulos |
First Address | Tarrytown, NY 10591-5139 |
Second Address | Islandia, NY 11749-5306 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2007 |
Last Update Date | 03/04/2019 |