Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 042733 | NY |
N | 1223D0001X | Dental Public Health | 042733 | NY |
Y | 1223G0001X | General Practice | 042733 | NY |
Y | 213EG0000X | General Practice | 042733 | NY |
NPI | 1417181017 |
---|---|
Provider Name | Robert Steven Popkin |
First Address | Port Washington, NY 11050-3737 |
Second Address | Port Washington, NY 11050-3737 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2009 |
Last Update Date | 24/09/2009 |