Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 140235 | NY |
NPI | 1043212442 |
---|---|
Provider Name | Juan E Yara |
First Address | Bronx, NY 10459-2417 |
Second Address | Bronx, NY 10459-2417 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2005 |
Last Update Date | 25/05/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00665274 | (05) | NY |
CO665274 | (02) | NY |