Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 050383 | NY |
NPI | 1073711271 |
---|---|
Provider Name | Jeffrey Rouse |
First Address | New York, NY 10007-3001 |
Second Address | New York, NY 10007-3001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2007 |
Last Update Date | 26/12/2013 |