Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223D0004X | Dentist Anesthesiologist | 051569 | NY |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 51569 | NY |
NPI | 1366432817 |
---|---|
Provider Name | Dr. Robert Mines |
First Address | Bronx, NY 10467-2625 |
Second Address | Bronx, NY 10467-2625 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2005 |
Last Update Date | 20/04/2021 |