Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | NY |
NPI | 1215962576 |
---|---|
Provider Name | Richard G Harwood |
First Address | Astoria, NY 11103 |
Second Address | Astoria, NY 11103 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00600615 | (05) | NY |
T81200 | (02) |