Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XP3100X | Pediatric Orthopaedic Surgeon | 200545 | NY |
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | MD434500 | PA |
NPI | 1730176678 |
---|---|
Provider Name | Harold J.p. Van Bosse |
First Address | Philadelphia, PA 19178-0001 |
Second Address | Philadelphia, PA 19140-4160 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2005 |
Last Update Date | 21/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01640257 | (05) | NY |
G15550 | (02) | NY |