Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | 177943 | NY |
NPI | 1003977125 |
---|---|
Provider Name | Dr. Roger Kersten |
First Address | Massapequa, NY 11758-1203 |
Second Address | Massapequa, NY 11758-1203 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2006 |
Last Update Date | 26/08/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E87389 | (02) |