Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | X005605-1 | NY |
NPI | 1104914191 |
---|---|
Provider Name | Dr. Philip Steven Gura |
First Address | East Rockaway, NY 11518-1530 |
Second Address | East Rockaway, NY 11518-1530 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5897788 | GHI (01) | NY |
808342 | MANAGED PHYSICAL NETWORK (01) | NY |
C05605-3 | WORKERS COMPENSATION (01) | NY |
P00123334 | PALMETTO GBA (01) | |
P3204341 | OXFORD HEALTH PLANS (01) | |
T81279 | (02) | NY |
X6F91 | BLUE CROSS BLUESHIELD (01) | NY |