Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 030393 | NY |
NPI | 1093724445 |
---|---|
Provider Name | Kenneth David Morris |
First Address | Plainview, NY 11803-5018 |
Second Address | Plainview, NY 11803-5018 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00386943 | (05) | NY |
T49377 | (02) |