Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 243565 | NY |
NPI | 1104066356 |
---|---|
Provider Name | Peter Connolly |
First Address | New York, NY 10065-4870 |
Second Address | New York, NY 10065-4870 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2009 |
Last Update Date | 19/12/2011 |