Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 199588 | NY |
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | 199588 | NY |
NPI | 1649298977 |
---|---|
Provider Name | Roger F. Widmann |
First Address | New York, NY 10087-9234 |
Second Address | New York, NY 10021-4823 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 27/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01580336 | (05) | NY |
F97410 | (02) |