Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 00782 | NY |
NPI | 1356531578 |
---|---|
Provider Name | Dr. Andrew Judson Millar |
First Address | Poughquag, NY 12570-5106 |
Second Address | Poughquag, NY 12570-5106 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2007 |
Last Update Date | 20/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
CO7820-6 | WORKER'S COMPENSATION (01) | NY |
U60563 | (02) | NY |