Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 261918 | NY |
NPI | 1003104191 |
---|---|
Provider Name | Yonatan Elstein |
First Address | New Square, NY 10977-8916 |
Second Address | New Square, NY 10977-8916 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2011 |
Last Update Date | 11/07/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
261918 | LICENSE (01) | NY |