Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | X3583 | NY |
NPI | 1275749426 |
---|---|
Provider Name | Dr. Paul Joseph Brooke |
First Address | Bay Shore, NY 11706-8420 |
Second Address | Bay Shore, NY 11706-8011 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2007 |
Last Update Date | 20/04/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
421629281 | TAX ID (01) | NY |