Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 222059 | NY |
NPI | 1538132154 |
---|---|
Provider Name | Dr. Mike M Pappas |
First Address | Huntington, NY 11743-0468 |
Second Address | Riverhead, NY 11901-2583 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2006 |
Last Update Date | 03/06/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02954685 | (05) | NY |
I03360 | (02) | NY |
P00319546 | RAILROAD MEDICARE (01) | NY |