Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | 185025 | NY |
NPI | 1104972561 |
---|---|
Provider Name | Mr. William Kennedy Main |
First Address | New York, NY 10021 |
Second Address | New York, NY 10021 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2007 |
Last Update Date | 07/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
185025 | LICENSE (01) | |
F76439 | (02) |