Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 48617 | NY |
NPI | 1134348410 |
---|---|
Provider Name | Kayhan Civelek |
First Address | New York, NY 10019-1436 |
Second Address | New York, NY 10019-1436 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2007 |
Last Update Date | 08/07/2007 |