Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 119994-1 | NY |
NPI | 1023015088 |
---|---|
Provider Name | Thaddeus J. Spak |
First Address | Huntington Station, NY 11746-1915 |
Second Address | Huntington Station, NY 11746-1915 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2005 |
Last Update Date | 25/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00225338 | (05) | NY |
B17323 | (02) | NY |