Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | 161391-1 | NY |
NPI | 1063560787 |
---|---|
Provider Name | Dr. Neville Clynes |
First Address | Suffern, NY 10901-3322 |
Second Address | New York, NY 10034-1159 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A61265 | (02) | NY |