Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 170172 | NY |
Y | 111NI0900X | Internist | 170172 | NY |
N | 208000000X | Pediatrician | 170172 | NY |
NPI | 1003873464 |
---|---|
Provider Name | Dr. Joseph R Sellers |
First Address | Cooperstown, NY 13326-0725 |
Second Address | Cobleskill, NY 12043-5111 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2006 |
Last Update Date | 06/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01163304 | (05) | NY |
E15732 | (02) | NY |