Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0300X | Periodontist | NJ | |
Y | 1223P0300X | Periodontist | 0427074 | NY |
NPI | 1033127030 |
---|---|
Provider Name | Mr. Thomas Rafferty |
First Address | Brooklyn, NY 11234 |
Second Address | Brooklyn, NY 11234 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2006 |
Last Update Date | 08/07/2007 |