Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 147313 | NY |
NPI | 1093898934 |
---|---|
Provider Name | Michael Chris Overby |
First Address | Great Neck, NY 11021-5302 |
Second Address | Woodmere, NY 11598-2144 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00958585 | (05) | NY |
B18679 | (02) | NY |