Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | P70907 | NY |
Y | 1223P0221X | Pediatric Dentist | 055050 | NY |
NPI | 1003044850 |
---|---|
Provider Name | Dr. Joel Michael Preminger |
First Address | Cedarhurst, NY 11516-2013 |
Second Address | Cedarhurst, NY 11516-2013 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2009 |
Last Update Date | 24/06/2013 |