Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | 297723 | NY |
NPI | 1225482706 |
---|---|
Provider Name | Dr. Joseph Ryan Bautista |
First Address | New York, NY 10010-3560 |
Second Address | New York, NY 10010-3560 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2016 |
Last Update Date | 27/04/2020 |