Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | X0002739-1 | NY |
NPI | 1467463588 |
---|---|
Provider Name | Dr. Peter Munda |
First Address | Glen Cove, NY 11542-2858 |
Second Address | Glen Cove, NY 11542-2858 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2006 |
Last Update Date | 08/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T52221 | (02) | NY |