Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 217258 | NY |
NPI | 1528082724 |
---|---|
Provider Name | Dr. Mohan Aiyaswami Pillai |
First Address | Edwardsville, PA 18704-4441 |
Second Address | Wilkes Barre, PA 18711-0030 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
VAD000 | (02) | PA |