Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 179725 | NY |
NPI | 1053345108 |
---|---|
Provider Name | Dr. Itchie Statfeld |
First Address | Brooklyn, NY 11211 |
Second Address | Brooklyn, NY 11211 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2006 |
Last Update Date | 08/05/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E94655 | (02) |