Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 010340 | NY |
NPI | 1174796098 |
---|---|
Provider Name | Kevin Doherty |
First Address | Hartsdale, NY 10530-2319 |
Second Address | Hartsdale, NY 10530-2319 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2008 |
Last Update Date | 11/04/2008 |