Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207W00000X | Ophthalmologist | 235037-1 | NY |
NPI | 1013983923 |
---|---|
Provider Name | Sean Mogan |
First Address | Webster, NY 14580-2907 |
Second Address | Webster, NY 14580-2907 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2006 |
Last Update Date | 04/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I34711 | (02) | NY |