Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 056087 | NY |
NPI | 1114272192 |
---|---|
Provider Name | Dr. Joshua Michael Chubak |
First Address | Lawrence, NY 11559-1803 |
Second Address | Lawrence, NY 11559-1803 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2012 |
Last Update Date | 10/08/2014 |