Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 033118 | NY |
NPI | 1093707036 |
---|---|
Provider Name | Dr. Seth Martin Black |
First Address | New York, NY 10021-8140 |
Second Address | New York, NY 10065-8140 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2005 |
Last Update Date | 07/08/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00707135 | (05) | NY |
T49477 | (02) |