Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 147211 | NY |
NPI | 1386651644 |
---|---|
Provider Name | Dr. Jonathan T. Deland |
First Address | New York, NY 10021-4872 |
Second Address | New York, NY 10021-4872 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2006 |
Last Update Date | 18/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B97948 | (02) | NY |