Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 135606 | NY |
N | 111NI0900X | Internist | 135606 | NY |
Y | 207RR0500X | Rheumatology | 135606 | NY |
NPI | 1053378950 |
---|---|
Provider Name | Dr. Gerald D Groff |
First Address | Cooperstown, NY 13326-0725 |
Second Address | Cooperstown, NY 13326-1301 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2006 |
Last Update Date | 05/11/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01162945 | (05) | NY |
B83112 | (02) | NY |