Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 179838 | NY |
N | 207QA0401X | Family Doctor - Addiction Medicine | 179838 | NY |
NPI | 1831181981 |
---|---|
Provider Name | Dr. Jose M. David JR. |
First Address | Albany, NY 12203-4253 |
Second Address | Albany, NY 12203-4253 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2005 |
Last Update Date | 09/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01270268 | (05) | NY |
E94508 | (02) | NY |