Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0201X | Gynecologic Oncologist | P96728 | NY |
NPI | 1356725642 |
---|---|
Provider Name | Joao Casanova Goncalves |
First Address | New York, NY 10065-6306 |
Second Address | New York, NY 10065-6007 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2015 |
Last Update Date | 16/07/2015 |