Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | N/A | ZZ |
NPI | 1316232986 |
---|---|
Provider Name | Dr. Lazaros Poultsides |
First Address | New York, NY 10021-4823 |
Second Address | New York, NY 10021-4823 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2011 |
Last Update Date | 14/05/2015 |