Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0202X | Pediatric Cardiologist | 114420 | NY |
NPI | 1275634164 |
---|---|
Provider Name | Shiv Kuman Dube |
First Address | Flushing, NY 11355 |
Second Address | Flushing, NY 11355 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00209467 | (05) | NY |
B77889 | (02) |