Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 28330 | NY |
NPI | 1043350853 |
---|---|
Provider Name | Dr. Terry Sobler |
First Address | Spring Valley, NY 10977-1960 |
Second Address | Spring Valley, NY 10977-1960 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01421705 | (05) | NY |