Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | N005221 | NY |
Y | 222Z00000X | Podiatrist | N005221 | NY |
NPI | 1023043049 |
---|---|
Provider Name | John Haight |
First Address | Valley Stream, NY 11580 |
Second Address | Valley Stream, NY 11580 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2006 |
Last Update Date | 27/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U59030 | (02) |