Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RA0201X | Internist - Allergy & Immunology | 185931 | NY |
Y | 207RI0200X | Infectious Disease | 185931 | NY |
NPI | 1568463545 |
---|---|
Provider Name | Eddie Go |
First Address | Arverne, NY 11692-1409 |
Second Address | Arverne, NY 11692-1409 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2005 |
Last Update Date | 01/03/2013 |