Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 121055 | NY |
NPI | 1053306480 |
---|---|
Provider Name | Isadore Phillip Gutwein |
First Address | Bronx, NY 10463-1845 |
Second Address | Bronx, NY 10463-1845 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2005 |
Last Update Date | 22/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00227069 | (05) | NY |
B20668 | (02) | NY |