Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 247296 | NY |
Y | 207R00000X | Internist | 247296 | NY |
Y | 111NI0900X | Internist | 247296 | NY |
N | 207RA0401X | Internist - Addiction Medicine | 247296 | NY |
NPI | 1235459009 |
---|---|
Provider Name | Dr. Michael Jay Winter |
First Address | Sayville, NY 11782-2730 |
Second Address | Sayville, NY 11782-2730 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2010 |
Last Update Date | 17/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1750806246 | PROVIDER (01) | NY |