Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 258352 | NY |
N | 207T00000X | Neurosurgeon | MD24962 | OR |
N | 207T00000X | Neurosurgeon | MD453180 | PA |
NPI | 1083726798 |
---|---|
Provider Name | Dr. Jorge Luis Eller |
First Address | Syracuse, NY 13204-2866 |
Second Address | Syracuse, NY 13210 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 12/08/2019 |