Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0105X | Surgery of the Hand | 103942 | NY |
NPI | 1407045446 |
---|---|
Provider Name | George Dermesropian |
First Address | Fulton, NY 13069-3069 |
Second Address | Fulton, NY 13069-3069 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2007 |
Last Update Date | 16/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02172205 | (05) | NY |
D09122 | (02) | NY |