Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 099341 | NY |
NPI | 1366486367 |
---|---|
Provider Name | Dr. Carl R Wirth |
First Address | Slingerlands, NY 12159-9793 |
Second Address | Slingerlands, NY 12159-9793 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
099341 | NEW YORK STATE LICENSE (01) | NY |