Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 130916 | NY |
NPI | 1285701896 |
---|---|
Provider Name | Dr. Peter Ruzohorsky |
First Address | Brooklyn, NY 11211-7672 |
Second Address | Brooklyn, NY 11211-7672 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
257965 | (05) | NY |