Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 0134361 | NY |
NPI | 1003008798 |
---|---|
Provider Name | Dr. Martin A. Sobel |
First Address | Setauket, NY 11733-1924 |
Second Address | Setauket, NY 11733-1924 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2007 |
Last Update Date | 16/08/2007 |