Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | P65166 | NY |
Y | 204E00000X | Oral & Maxillofacial Surgeon | 0562221 | NY |
NPI | 1063743458 |
---|---|
Provider Name | Dr. Patrick J Nolan |
First Address | Bronx, NY 10467-2836 |
Second Address | Bronx, NY 10467-2836 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2010 |
Last Update Date | 26/11/2019 |