Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 151571-1 | NY |
NPI | 1043225857 |
---|---|
Provider Name | Vlado Simko |
First Address | Staten Island, NY 10301-4421 |
Second Address | Brooklyn, NY 11209-7104 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2006 |
Last Update Date | 08/07/2007 |