Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | 287568 | NY |
NPI | 1104143239 |
---|---|
Provider Name | Michael Tracy Mcway |
First Address | Brooklyn, NY 11215 |
Second Address | Brooklyn, NY 11215-3609 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/04/2010 |
Last Update Date | 17/06/2017 |