Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0203X | Pediatric Critical Care Doctor | 226146 | NY |
NPI | 1245231224 |
---|---|
Provider Name | Matthew J Kapklein |
First Address | Valhalla, NY 10595-1530 |
Second Address | Valhalla, NY 10595-1530 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2005 |
Last Update Date | 25/03/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003122570 | (05) | CT |
01665796 | (05) | NY |
1012089470001 | (05) | PA |
A400040118 | MEDICARE PTAN (01) | NY |
G34430 | (02) | NY |