Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174V00000X | Clinical Ethicist |
NPI | 1326664350 |
---|---|
Provider Name | Jorge Luis Rivera Agosto |
First Address | Woodside, NY 11377-4602 |
Second Address | New Hyde Park, NY 11040-1402 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2020 |
Last Update Date | 25/06/2020 |