Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 149774 | NY |
N | 208600000X | Surgeon | 149774 | NY |
N | 2082S0105X | Plastic Hand Surgeon | 149774 | NY |
NPI | 1699832667 |
---|---|
Provider Name | Dr. Ignatius Daniel Roger |
First Address | Elmhurst, NY 11373 |
Second Address | Elmhurst, NY 11373 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00711739 | (05) | NY |
B03613 | (02) | NY |