Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 122445 | NY |
NPI | 1174517999 |
---|---|
Provider Name | Thomas Riles |
First Address | New York, NY 10016-6402 |
Second Address | New York, NY 10016-6402 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2005 |
Last Update Date | 10/12/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00230286 | (05) | NY |
A62132 | (02) | NY |