Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 177324 | NY |
Y | 207Q00000X | Family Doctor | 177324 | NY |
N | 207QA0401X | Family Doctor - Addiction Medicine | 177324 | NY |
NPI | 1497831721 |
---|---|
Provider Name | Charles Benjamin King |
First Address | North Chili, NY 14514-9796 |
Second Address | Batavia, NY 14020 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/10/2006 |
Last Update Date | 17/09/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01202235 | (05) | NY |
F04490 | (02) |