Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 162460 | NY |
NPI | 1003964446 |
---|---|
Provider Name | Jan Schreuder |
First Address | Massapequa Park, NY 11762-0270 |
Second Address | New York, NY 10028-7907 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2007 |
Last Update Date | 14/10/2010 |