Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 114345 | NY |
NPI | 1427108588 |
---|---|
Provider Name | Robert Mayo Israel |
First Address | New York, NY 10021 |
Second Address | New York, NY 10021 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2007 |
Last Update Date | 08/07/2007 |