Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 126456 | NY |
NPI | 1750347423 |
---|---|
Provider Name | Dr. Ignatius Cyriac |
First Address | Deer Park, NY 11729-2722 |
Second Address | Deer Park, NY 11729-2722 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2006 |
Last Update Date | 25/04/2011 |