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Individual
NEIL D THEISE
Active
Individual
NEIL D THEISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207ZP0101X
Anatomic Pathology Physician
Primary
171759
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02441078
—
NY
01
—
92F8970211
NGS
NY
Enumeration date
07/20/2005
Last updated
02/01/2012
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