Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 165177 | NY |
NPI | 1083722896 |
---|---|
Provider Name | Dr. James Roy Taylor JR. |
First Address | Stony Brook, NY 11794-8191 |
Second Address | Stony Brook, NY 11794-8191 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2006 |
Last Update Date | 12/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01248948 | (05) | NY |
E17704 | (02) | NY |