Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 216820 | NY |
NPI | 1982649034 |
---|---|
Provider Name | Worku B Zewdu |
First Address | Bronx, NY 10468-3961 |
Second Address | Bronx, NY 10468-3961 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2006 |
Last Update Date | 02/12/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H32733 | (02) | NY |