Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 050168 | NY |
NPI | 1013930411 |
---|---|
Provider Name | Dr. Michael Fredrick Leifert |
First Address | New York, NY 10011-8859 |
Second Address | New York, NY 10011-8859 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2006 |
Last Update Date | 08/07/2007 |