Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 36233 | NY |
NPI | 1144316852 |
---|---|
Provider Name | Dr. Paul J. Legunn |
First Address | New City, NY 10956-4305 |
Second Address | New City, NY 10956-4305 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 08/07/2007 |