Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 154324 | NY |
NPI | 1669472676 |
---|---|
Provider Name | Mitchell Barry Boxer |
First Address | Great Neck, NY 11021 |
Second Address | Great Neck, NY 11021 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2005 |
Last Update Date | 11/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B20310 | (02) |