Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | 205722-1 | NY |
NPI | 1427116516 |
---|---|
Provider Name | Dr. Bruce Andrew Maslack |
First Address | Amsterdam, NY 12010 |
Second Address | Amsterdam, NY 12010 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01885432 | (05) | NY |
E54951 | (02) |