Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | 165613 | NY |
NPI | 1396856589 |
---|---|
Provider Name | Dr. Stuart Lyle Bohrer |
First Address | Mineola, NY 11501-3957 |
Second Address | Mineola, NY 11501-3957 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 27/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00973726 | (05) | NY |
A63822 | (02) |