Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0201X | Internist - Allergy & Immunology | 083564 | NY |
NPI | 1982048575 |
---|---|
Provider Name | Dr. Joel Stewart Gitlin |
First Address | Southampton, NY 11968-5322 |
Second Address | Southampton, NY 11968-5322 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2013 |
Last Update Date | 25/04/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
083564 | MEDICAL LICENCE NUMBER (01) | NY |
083564 | NEW YORK STATE MEDICAL LICENSE NUMBER: (01) | NY |