Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 247591 | NY |
NPI | 1003822743 |
---|---|
Provider Name | Dr. Aaron Dale Huizenga |
First Address | Clayton, NY 13624-1409 |
Second Address | Clayton, NY 13624-1409 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2006 |
Last Update Date | 04/02/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03477034 | (05) | NY |
I57974 | (02) |