Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 089645 | NY |
NPI | 1609871573 |
---|---|
Provider Name | Dr. Jonathan Logan |
First Address | Canandaigua, NY 14424-1727 |
Second Address | Canandaigua, NY 14424-1727 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2005 |
Last Update Date | 26/01/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00025452201 | UNIVERA (01) | NY |
030001160 | RAILROAD MEDICARE (01) | NY |
100497AA | PREFERRED CARE AL (01) | NY |
100497DT | PREFERRED CARE PA (01) | NY |
1360 | EXCELLUS BLUE SHIELD (01) | NY |
5176319 | AETNA (01) | NY |
D74846 | (02) | NY |
P010089546 | EXCELLUS BLUE CHOICE (01) | NY |