Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | 145809 | NY |
NPI | 1033174511 |
---|---|
Provider Name | Mr. Ainsley George Pennant |
First Address | New York, NY 10013-4006 |
Second Address | Brooklyn, NY 11221 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2006 |
Last Update Date | 14/02/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
49A281 | (02) | |
B15294 | (02) |