Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | 0861301 | NY |
NPI | 1629154448 |
---|---|
Provider Name | Martin Winick |
First Address | Huntington, NY 11743 |
Second Address | Huntington, NY 11743 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00132852 | (05) | NY |
175881 | BXBS (01) | NY |
B10468 | (02) |