Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 1993 | CT |
NPI | 1295136000 |
---|---|
Provider Name | Kyle J Bean |
First Address | Riverside, CT 06878-1426 |
Second Address | Riverside, CT 06878-1426 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/09/2014 |
Last Update Date | 04/02/2015 |