Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | N004149 | NY |
NPI | 1255369997 |
---|---|
Provider Name | Dr. Pedro Smukler |
First Address | Brooklyn, NY 11230-1708 |
Second Address | Brooklyn, NY 11206-3203 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2006 |
Last Update Date | 24/09/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01007390 | (05) | NY |
T51382 | (02) | NY |