Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207U00000X | Nuclear Medicine Specialist | 240718 | NY |
NPI | 1528146818 |
---|---|
Provider Name | Jorge A Carrasquillo |
First Address | New York, NY 10017-6706 |
Second Address | New York, NY 10021-6007 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2006 |
Last Update Date | 08/07/2007 |