Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | N005123 | NY |
NPI | 1093776882 |
---|---|
Provider Name | Dr. Paul Atlas |
First Address | Monticello, NY 12701-1742 |
Second Address | Monticello, NY 12701-1742 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2006 |
Last Update Date | 31/05/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01559791 | (05) | NY |
0441090001 | MEDICARE DMERC (01) | NY |
U52091 | (02) | NY |