Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 132580 | NY |
N | 225000000X | Orthotic Fitter | 132580 | NY |
NPI | 1003811811 |
---|---|
Provider Name | Jay W Eneman |
First Address | Woodmere, NY 11598-0330 |
Second Address | Long Beach, NY 11561-2238 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2005 |
Last Update Date | 06/06/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B12688 | (02) | NY |