Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | N004398-1 | NY |
NPI | 1093811564 |
---|---|
Provider Name | Dr. John J Jurcisin |
First Address | New York, NY 10022-3614 |
Second Address | New York, NY 10022-1236 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2006 |
Last Update Date | 01/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T81553 | (02) | NY |