Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 228460 | NY |
Y | 2080P0214X | Pediatric Pulmonologist | 228460 | NY |
NPI | 1629168893 |
---|---|
Provider Name | Stefan Worgall |
First Address | New York, NY 10021-4635 |
Second Address | New York, NY 10021-4635 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2006 |
Last Update Date | 20/09/2011 |