Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 184886 | NY |
NPI | 1114982105 |
---|---|
Provider Name | Thomas J Lovely |
First Address | Latham, NY 12110-1000 |
Second Address | Latham, NY 12110-1000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2006 |
Last Update Date | 20/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E89440 | (02) |