Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 185448 | NY |
NPI | 1063444321 |
---|---|
Provider Name | Dr. Roger Koreen |
First Address | Huntington, NY 11743 |
Second Address | Huntington, NY 11743 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E84288 | (02) |