Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0102X | Surgical Critical Care | 263018 | NY |
N | 2086S0102X | Surgical Critical Care | ME128544 | FL |
NPI | 1003054214 |
---|---|
Provider Name | Krassimir Atanassov |
First Address | Middletown, NY 10940-2650 |
Second Address | Middletown, NY 10940-2650 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2009 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03596898 | (05) | NY |