Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2082S0105X | Plastic Hand Surgeon | 125470 | NY |
NPI | 1740376151 |
---|---|
Provider Name | Dr. Marciano I Miclat JR. |
First Address | Larchmont, NY 10538-1018 |
Second Address | Larchmont, NY 10538-1018 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B12880 | (02) | NY |