Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 031806 | NY |
NPI | 1134337389 |
---|---|
Provider Name | Dr. Robert Stephen Gureasko |
First Address | South Salem, NY 10590-1018 |
Second Address | New York, NY 10035-3832 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2007 |
Last Update Date | 06/03/2019 |