Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 0466871 | NY |
NPI | 1083838254 |
---|---|
Provider Name | Dr. Nick Mastromihalis |
First Address | Mount Kisco, NY 10549-3439 |
Second Address | Mount Kisco, NY 10549-3439 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2007 |
Last Update Date | 08/07/2007 |