Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086X0206X | Surgical Oncologist | P92540 | NY |
NPI | 1023428869 |
---|---|
Provider Name | Ismael Dominguez Rosado |
First Address | New York, NY 10065-6342 |
Second Address | New York, NY 10065-6007 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2014 |
Last Update Date | 01/05/2014 |