Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 028630 | NY |
NPI | 1235178922 |
---|---|
Provider Name | Dr. I Michael Postol |
First Address | Valley Stream, NY 11580-1513 |
Second Address | Jamaica, NY 11434-1428 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2006 |
Last Update Date | 10/04/2008 |