Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 252491-1 | NY |
NPI | 1013151851 |
---|---|
Provider Name | Joshua Jedwab |
First Address | Cedarhurst, NY 11516-1128 |
Second Address | Cedarhurst, NY 11516-1128 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2009 |
Last Update Date | 23/04/2009 |