Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223D0004X | Dentist Anesthesiologist | 056107 | NY |
Y | 1223P0221X | Pediatric Dentist | 056107 | NY |
NPI | 1386931095 |
---|---|
Provider Name | Dr. John Timothy Hansford JR. |
First Address | Brooklyn, NY 11222-2934 |
Second Address | Commack, NY 11725-2937 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2011 |
Last Update Date | 17/05/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
131740114 | (05) | NY |