Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 191510 | NY |
NPI | 1053362103 |
---|---|
Provider Name | Dr. Alexander Kendrat Mandych |
First Address | Orchard Park, NY 14127-1236 |
Second Address | Orchard Park, NY 14127-1236 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G75601 | (02) | NY |