Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 172482 | NY |
NPI | 1043205982 |
---|---|
Provider Name | Dr. Bohdan Dejneka |
First Address | Amherst, NY 14226-2925 |
Second Address | Amherst, NY 14226-2925 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2005 |
Last Update Date | 08/07/2007 |