Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0402X | Child Neurologist | 185534 | NY |
NPI | 1073609327 |
---|---|
Provider Name | Dr. John Timothy Wells |
First Address | New York, NY 10021-5901 |
Second Address | New York, NY 10021-5901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G05621 | (02) | NY |