Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0106X | Oral and Maxillofacial Pathology | 053051 | NY |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 053051 | NY |
NPI | 1841439411 |
---|---|
Provider Name | Dr. Keith Murtagh |
First Address | Island Park, NY 11558-1305 |
Second Address | Brooklyn, NY 11212-3139 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2009 |
Last Update Date | 06/07/2013 |