Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 054361 | NY |
NPI | 1154670057 |
---|---|
Provider Name | Dr. Robert B Bowe |
First Address | Staten Island, NY 10314-5461 |
Second Address | Staten Island, NY 10314-5461 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2012 |
Last Update Date | 06/09/2012 |