Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 138452 | NY |
Y | 207QA0401X | Family Doctor - Addiction Medicine | 138452 | NY |
NPI | 1588614275 |
---|---|
Provider Name | Dr. George A Disney |
First Address | Plattsburgh, NY 12901-0259 |
Second Address | Plattsburgh, NY 12901-1893 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2006 |
Last Update Date | 25/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00688055 | (05) | NY |
01420795 | (05) | NY |
01420800 | (05) | NY |
B82866 | (02) | NY |