Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0100X | Occupational Health | X004756-1 | NY |
NPI | 1184702243 |
---|---|
Provider Name | Dr. Robert Joseph Shane |
First Address | Syracuse, NY 13209-1555 |
Second Address | Syracuse, NY 13209-1555 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2006 |
Last Update Date | 27/04/2009 |