Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 021132 | NY |
Y | 213ES0000X | Sports Medicine | 021132 | NY |
NPI | 1245755883 |
---|---|
Provider Name | Mr. Yitzchak Shollar |
First Address | Brooklyn, NY 11234-2617 |
Second Address | Brooklyn, NY 11234-2617 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2017 |
Last Update Date | 04/08/2017 |