Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0205X | Pediatric Endocrinologist | 173866 | NY |
NPI | 1356308548 |
---|---|
Provider Name | Dr. Levon Agdere |
First Address | New York, NY 10087-6246 |
Second Address | Brooklyn, NY 11233-3677 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2006 |
Last Update Date | 01/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E17742 | (02) | NY |