Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | 129273 | NY |
NPI | 1053306233 |
---|---|
Provider Name | Mark Jarrett |
First Address | Staten Island, NY 10301-3915 |
Second Address | Staten Island, NY 10301-3915 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B17506 | (02) | NY |