Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 040858-1 | NY |
NPI | 1003827916 |
---|---|
Provider Name | Ronald David Mizrahi |
First Address | Brooklyn, NY 11223-4033 |
Second Address | Brooklyn, NY 11223-4033 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01349375 | (05) | NY |