Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 253201 | NY |
NPI | 1063709574 |
---|---|
Provider Name | Dr. Merritt Drew Kinon |
First Address | Bronx, NY 10467-2401 |
Second Address | Bronx, NY 10467 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2011 |
Last Update Date | 29/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
MEDICAID | 04230599 (01) | NY |