Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 036695 | NY |
NPI | 1730268970 |
---|---|
Provider Name | Dr. Victor Badner |
First Address | Larchmont, NY 10538-1728 |
Second Address | Bronx, NY 10461-1138 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01717220 | (05) | NY |