Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 153648 | NY |
Y | 208600000X | Surgeon | 153648 | NY |
NPI | 1003854126 |
---|---|
Provider Name | Jean Claude Bayle |
First Address | Long Island City, NY 11102-2744 |
Second Address | Long Island City, NY 11102-2448 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E71436 | (02) | NY |