Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 45PO00013300 | NJ |
N | 222Z00000X | Podiatrist | 45PO00013300 | NJ |
N | 224P00000X | Prosthetist | 45PO00013300 | NJ |
NPI | 1417923103 |
---|---|
Provider Name | Mr. Thaddeus Edward Drygas |
First Address | Nanuet, NY 10954-5203 |
Second Address | Nanuet, NY 10954-5203 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2006 |
Last Update Date | 18/11/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01703433 | (05) | NY |