Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | 288616 | NY |
N | 2084N0400X | Neurologist | 42243 | KY |
NPI | 1043474844 |
---|---|
Provider Name | Christopher M King |
First Address | Ithaca, NY 14850-1871 |
Second Address | Ithaca, NY 14850-1871 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2008 |
Last Update Date | 17/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0228 | MEDICARE GROUP (01) | KY |
42243 | KENTUCKY BOARD OF MEDICAL LICENSURE: LICENSE (01) | KY |
TP985 | KY TEMP LICENSE (01) | KY |