Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 30399 | NY |
NPI | 1013165497 |
---|---|
Provider Name | Michael K. Emanuel |
First Address | Brooklyn, NY 11229 |
Second Address | Brooklyn, NY 11229 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2008 |
Last Update Date | 28/08/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01779620 | (05) | NY |