Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 1127940 | NY |
Y | 222Z00000X | Podiatrist | 1127940 | NY |
N | 224P00000X | Prosthetist | 1127940 | NY |
NPI | 1174696736 |
---|---|
Provider Name | Mr. Bethanapalli Bose |
First Address | Fair Lawn, NJ 07410-3802 |
Second Address | Brooklyn, NY 11228-1101 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2006 |
Last Update Date | 01/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00835727 | (05) | NY |