Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2084N0400X | Neurologist | 175797 | NY |
N | 2084N0402X | Child Neurologist | 175797 | NY |
NPI | 1093733594 |
---|---|
Provider Name | Freddie M Marton |
First Address | Cedarhurst, NY 11516 |
Second Address | Cedarhurst, NY 11516 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F25849 | (02) |