Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | 213142-1 | NY |
NPI | 1235106493 |
---|---|
Provider Name | Lennox O'neil Bryson |
First Address | East Meadow, NY 11554-1859 |
Second Address | East Meadow, NY 11554-1859 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2006 |
Last Update Date | 10/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02126603 | (05) | NY |
H56493 | (02) | NY |