Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 18492 | MA |
NPI | 1023125093 |
---|---|
Provider Name | Dr. Sheldon Jay Itzkowitz |
First Address | S Attleboro, MA 02703 |
Second Address | S Attleboro, MA 02703 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2006 |
Last Update Date | 08/07/2007 |