Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 160062 | NY |
NPI | 1093783078 |
---|---|
Provider Name | Dr. Jon David Kirwin |
First Address | New York, NY 10008-3383 |
Second Address | Brooklyn, NY 11203-1901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2006 |
Last Update Date | 06/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01557735 | (05) | NY |
F42615 | (02) | NY |