Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 024413 | NY |
NPI | 1932321205 |
---|---|
Provider Name | Dr. Jose Manuel Delgado |
First Address | Jackson Heights, NY 11372 |
Second Address | Jackson Heights, NY 11372 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01385015 | (05) | NY |