Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 143070 | NY |
NPI | 1093736860 |
---|---|
Provider Name | Jung G Oh |
First Address | Islip, NY 11751-3103 |
Second Address | Islip, NY 11751-3103 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2006 |
Last Update Date | 12/11/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A64215 | (02) | NY |