Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 119705 | NY |
NPI | 1033169883 |
---|---|
Provider Name | Jon M Reckler |
First Address | New York, NY 10022-4707 |
Second Address | New York, NY 10022-4707 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2006 |
Last Update Date | 09/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B17962 | (02) | NY |