Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207U00000X | Nuclear Medicine Specialist | 1100721 | NY |
NPI | 1093852980 |
---|---|
Provider Name | Wilfrido Mercado Sy |
First Address | Brooklyn, NY 11201 |
Second Address | Brooklyn, NY 11201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00716454 | (05) | NY |
A63958 | (02) |