Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 045900-1 | NY |
NPI | 1043236805 |
---|---|
Provider Name | Dr. Michael A Caruso |
First Address | White Plains, NY 10601-4710 |
Second Address | White Plains, NY 10601-4710 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U81079 | (02) | NY |