Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 048910 | NY |
NPI | 1114010626 |
---|---|
Provider Name | Michael Pikus |
First Address | Manhasset, NY 11030 |
Second Address | Manhasset, NY 11030 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2006 |
Last Update Date | 08/07/2007 |