Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 26425 | NY |
NPI | 1043248354 |
---|---|
Provider Name | Dr. Paul Edward Gould |
First Address | Nanuet, NY 10954-1929 |
Second Address | Nanuet, NY 10954-1929 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
747960 | AETNA (01) | NY |
RS285 | OXFORD (01) | NY |
T50034 | (02) | NY |