Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | 201871 | NY |
NPI | 1255442513 |
---|---|
Provider Name | Guy J Pean |
First Address | Brooklyn, NY 11203-5801 |
Second Address | New York, NY 10035-2906 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 11/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01701431 | (05) | NY |
G38126 | (02) |