Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | 188585 | NY |
NPI | 1104892488 |
---|---|
Provider Name | Peter Steven Midulla |
First Address | New York, NY 10029-6501 |
Second Address | New York, NY 10029-6574 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2006 |
Last Update Date | 06/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01936185 | (05) | NY |
G91862 | (02) |