Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | X00307-4-1 | NY |
NPI | 1003081225 |
---|---|
Provider Name | Dr. Terence Dulin |
First Address | Farmingdale, NY 11735-2504 |
Second Address | Farmingdale, NY 11735-2504 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/04/2008 |
Last Update Date | 29/04/2008 |