Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | 156672-1 | NY |
NPI | 1538138615 |
---|---|
Provider Name | Dr. Gregory Asa Max |
First Address | Oswego, NY 13126 |
Second Address | Oswego, NY 13126 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2006 |
Last Update Date | 10/04/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01822595 | (05) | NY |
578261 | (02) | NY |