Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | N006769-1 | NY |
NPI | 1356789820 |
---|---|
Provider Name | Fejzo Cecunjanin |
First Address | Brooklyn, NY 11219-3562 |
Second Address | Brooklyn, NY 11219-3562 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2013 |
Last Update Date | 09/09/2016 |