Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 006707 | NY |
Y | 222Z00000X | Podiatrist | 006707 | NY |
N | 213ES0131X | Foot Surgery | 006707 | NY |
NPI | 1073552105 |
---|---|
Provider Name | Dr. Andrew S Black |
First Address | Elmira, NY 14901-3230 |
Second Address | Horseheads, NY 14845-8302 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2006 |
Last Update Date | 20/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
04308852 | (05) | NY |
103755030 | (05) | PA |
T44914 | (02) | NJ |