Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 041096-1 | NY |
NPI | 1023140225 |
---|---|
Provider Name | Dr. Lawrence Edward Brecht |
First Address | New York, NY 10016-1101 |
Second Address | New York, NY 10016-1101 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/03/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D6I851 | (02) | NY |