Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | 304561 | NY |
NPI | 1497191423 |
---|---|
Provider Name | Matthew J Hanlon |
First Address | Syracuse, NY 13212-4516 |
Second Address | Syracuse, NY 13210 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2013 |
Last Update Date | 20/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
06067101 | (05) | NY |