Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | 211804 | NY |
N | 207RI0200X | Infectious Disease | 53630 | KY |
NPI | 1063464519 |
---|---|
Provider Name | Charles Kutler |
First Address | Kingston, NY 12401-3702 |
Second Address | Kingston, NY 12401-5144 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2006 |
Last Update Date | 30/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02361677 | (05) | NY |
H80446 | (02) |