Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | DS024223L | PA |
NPI | 1134346315 |
---|---|
Provider Name | Michael Edward Gonsky |
First Address | Stroudsburg, PA 18360-1221 |
Second Address | Stroudsburg, PA 18360-1221 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2007 |
Last Update Date | 08/07/2007 |