Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | F301625 | NY |
NPI | 1003802786 |
---|---|
Provider Name | Amy Elizabeth Roy |
First Address | Syracuse, NY 13210-1892 |
Second Address | Syracuse, NY 13210-1892 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02054680 | (05) | NY |
MR0255201 | DEA (01) | NY |
S34082 | (02) |