Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | X002497-1 | NY |
NPI | 1992878854 |
---|---|
Provider Name | Dr. John P. Detone |
First Address | Tuckahoe, NY 10707-1706 |
Second Address | Tuckahoe, NY 10707-1706 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T52195 | (02) | NY |