Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 123809 | NY |
NPI | 1235140542 |
---|---|
Provider Name | Richard Gary Conway |
First Address | Brooklyn, NY 11230-5572 |
Second Address | Brooklyn, NY 11230-5572 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2006 |
Last Update Date | 01/08/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00581411 | (05) | NY |
A62042 | (02) | NY |