Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | 272302 | NY |
NPI | 1013214535 |
---|---|
Provider Name | Songchuan Guo |
First Address | Brooklyn, NY 11220-4209 |
Second Address | Brooklyn, NY 11220-4209 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/02/2011 |
Last Update Date | 25/09/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
04056093 | (05) | NY |