Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | ME132179 | FL |
Y | 207QS0010X | Family Doctor - Sports Medicine | 293059 | NY |
NPI | 1295154730 |
---|---|
Provider Name | Mckirven Ceus |
First Address | Nyack, NY 10960-3001 |
Second Address | Nyack, NY 10960-3001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2014 |
Last Update Date | 03/01/2022 |