Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | 235596 | NY |
NPI | 1003889924 |
---|---|
Provider Name | Dr. Ethan L Gundeck |
First Address | Poughkeepsie, NY 12601-3923 |
Second Address | Fishkill, NY 12524 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2006 |
Last Update Date | 07/09/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02668160 | (05) | NY |
632P31 | (02) | NY |
H57874 | (02) | NY |