Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 061919 | NY |
NPI | 1093273070 |
---|---|
Provider Name | Dr. Matthew B Taylor |
First Address | Valley Stream, NY 11581-1836 |
Second Address | Stony Brook, NY 11790-3000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2019 |
Last Update Date | 24/09/2021 |