Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | NOO4717 | NY |
Y | 222Z00000X | Podiatrist | NOO4717 | NY |
NPI | 1043392582 |
---|---|
Provider Name | Michael Anthony Conway |
First Address | North Massapequa, NY 11758-2352 |
Second Address | North Massapequa, NY 11758-2352 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U18059 | (02) | NY |