Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0129X | Vascular Surgeon | 298106 | NY |
Y | 2086S0129X | Vascular Surgeon | 69564 | CT |
NPI | 1033539705 |
---|---|
Provider Name | John Phair |
First Address | New York, NY 10029-5210 |
Second Address | Long Island City, NY 11102 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/04/2014 |
Last Update Date | 19/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8168138 | (05) | NY |