Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 238757 | NY |
NPI | 1033223276 |
---|---|
Provider Name | Dr. Jonah Marshall |
First Address | Albany, NY 12212-4890 |
Second Address | Albany, NY 12208-1743 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2006 |
Last Update Date | 21/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02840637 | (05) | NY |