Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 034252 | NY |
NPI | 1114928330 |
---|---|
Provider Name | Ferdinand Gustav Neurohr III |
First Address | Bellmore, NY 11710-3431 |
Second Address | New York, NY 10022-5501 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2005 |
Last Update Date | 08/07/2007 |