Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | X2643 | NY |
NPI | 1407927833 |
---|---|
Provider Name | Dr. Robert M Fogel |
First Address | Nyack, NY 10960-2206 |
Second Address | Bronx, NY 10463 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T52148 | (02) | NY |