Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 131901 | NY |
NPI | 1184723587 |
---|---|
Provider Name | Richard L Parker |
First Address | Valley Stream, NY 11580-5444 |
Second Address | Valley Stream, NY 11580-5407 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2006 |
Last Update Date | 13/03/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C07403 | (02) | NY |