Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0102X | Surgical Critical Care | 110839 | NY |
NPI | 1093724395 |
---|---|
Provider Name | Tindalo Adaniel |
First Address | Orangeburg, NY 10962-2109 |
Second Address | Brooklyn, NY 11235-7745 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00198265 | (05) | NY |
B16505 | (02) | NY |