Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207ND0900X | Dermatopathologist | 217020 | NY |
NPI | 1487640439 |
---|---|
Provider Name | Shane Meehan |
First Address | New York, NY 10016-2708 |
Second Address | New York, NY 10016-2708 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2005 |
Last Update Date | 29/12/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H12681 | (02) | NY |