Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0000X | Hematologist | 155671 | NY |
NPI | 1235186065 |
---|---|
Provider Name | Mathew Lonberg |
First Address | Nyack, NY 10960-1824 |
Second Address | Nyack, NY 10960-1824 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2006 |
Last Update Date | 06/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A61427 | (02) |