Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 0429661 | NY |
NPI | 1174531081 |
---|---|
Provider Name | Dr. Ronald Scott Sambursky |
First Address | Johnson City, NY 13790 |
Second Address | Johnson City, NY 13790 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02242193 | (05) | NY |
U36282 | (02) |