Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | ||
N | 222Z00000X | Podiatrist | ||
Y | 224P00000X | Prosthetist |
NPI | 1184869521 |
---|---|
Provider Name | Mr. Joshua Jon Mullen |
First Address | Syracuse, NY 13210-2716 |
Second Address | Syracuse, NY 13210-2716 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2008 |
Last Update Date | 15/12/2008 |