Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 091860 | NY |
NPI | 1285884171 |
---|---|
Provider Name | Dr. John C Powers |
First Address | Neponsit, NY 11694 |
Second Address | Neponsit, NY 11694 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2008 |
Last Update Date | 26/09/2008 |