Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 204344-1 | NY |
NPI | 1124247192 |
---|---|
Provider Name | Anita G Amidon |
First Address | New Hartford, NY 13413-4401 |
Second Address | New Hartford, NY 13413-1037 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G35708 | (02) |