Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 166745 | NY |
NPI | 1003839598 |
---|---|
Provider Name | Mr. Rodolfo Comuyog Uy |
First Address | Bronx, NY 10466-1201 |
Second Address | Bronx, NY 10466-1201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2006 |
Last Update Date | 15/05/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00968790 | (05) | NY |
166745 | LICENSE (01) | NY |
A64220 | (02) | NY |