Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 149775 | NY |
NPI | 1003976283 |
---|---|
Provider Name | William Anthony Rose |
First Address | Middletown, NY 10940 |
Second Address | Middletown, NY 10940 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00697865 | (05) | NY |
B79238 | (02) |