Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 194788 | NY |
NPI | 1013982941 |
---|---|
Provider Name | Mr. Ronald Michael Dunphy |
First Address | Islip, NY 11751-3222 |
Second Address | Islip, NY 11751-3222 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2006 |
Last Update Date | 19/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01837154 | (05) | NY |
1434851 | EMPIRE UHC (01) | NY |
G21381 | (02) | NY |