Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 053598-1 | NY |
Y | 204E00000X | Oral & Maxillofacial Surgeon | 053598 | NY |
NPI | 1003085036 |
---|---|
Provider Name | Mr. Joshua Ethan Gish |
First Address | Selden, NY 11784 |
Second Address | Selden, NY 11784 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/02/2008 |
Last Update Date | 11/10/2012 |