Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 3908761 | NY |
NPI | 1023188349 |
---|---|
Provider Name | Robert Mccallion |
First Address | Huntington, NY 11743-3399 |
Second Address | Huntington, NY 11743-3399 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2006 |
Last Update Date | 12/06/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
S72136 | (02) |