Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 046879 | NY |
NPI | 1093778102 |
---|---|
Provider Name | Dr. Mark Stein |
First Address | Staten Island, NY 10305-3408 |
Second Address | Staten Island, NY 10305-3408 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02318014 | (05) | NY |
U84943 | (02) | NY |