Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 179353 | MD |
NPI | 1013960210 |
---|---|
Provider Name | Saul Michael Modlin |
First Address | Garden City, NY 11530-3330 |
Second Address | Garden City, NY 11530-3330 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F38829 | (02) |