Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0201X | Gynecologic Oncologist | 086209 | NY |
NPI | 1356342133 |
---|---|
Provider Name | Robert Wallach |
First Address | New York, NY 10016 |
Second Address | New York, NY 10016-2708 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2005 |
Last Update Date | 05/11/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D47538 | (02) | NY |