Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207U00000X | Nuclear Medicine Specialist | 107225 | NY |
NPI | 1508940354 |
---|---|
Provider Name | Jack Shamoun |
First Address | Latham, NY 12110-2442 |
Second Address | Latham, NY 12110 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2006 |
Last Update Date | 08/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00369466 | (05) | NY |
B80911 | (02) | NY |