Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 143777 | NY |
NPI | 1013043140 |
---|---|
Provider Name | Dr. Anthony M. Avellanosa |
First Address | Amherst, NY 14226-1206 |
Second Address | Amherst, NY 14226-1206 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B71700 | (02) | NY |