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Provider Information for 1437316379

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know


Gender: MALE

Individual NPI: 1437316379

Calendar   Last Updated:  2014-06-16
  Certification Date: 


Name Value
NPI 1437316379
Enumeration Date 2008-05-19
NPI Type 1 - Individual
Sole Proprietor YES
Status Active
Mailing Address 553 BROOKLINE AVE APT 6
BROOKLINE, MA 02445-5444
United States

Phone: | Fax:
View Map External Link
Primary Practice Address 525 E 68TH ST
NEW YORK, NY 10065-4870
United States

Phone: 212-746-3131 | Fax:
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Primary Taxonomy Selected Taxonomy State License Number
Yes 2080P0203X - Pediatrics Pediatric Critical Care Medicine MA 246686