Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 26659 | NY |
NPI | 1003956764 |
---|---|
Provider Name | Dr. Gerald Mark Sweder |
First Address | New York, NY 10019-3211 |
Second Address | New York, NY 10019-3211 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
GMSDDS200W | (02) | NY |