Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 002230 | NY |
N | 2080P0208X | Pediatric Infectious Diseases | 002230 | NY |
NPI | 1598865487 |
---|---|
Provider Name | Stefan Hagmann |
First Address | Bronx, NY 10457-7628 |
Second Address | Bronx, NY 10457-7628 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2006 |
Last Update Date | 12/07/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02602564 | (05) | NY |