Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 278957 | NY |
NPI | 1114930021 |
---|---|
Provider Name | Dr. Kristian O. Hochberg |
First Address | Elmira, NY 14901-3230 |
Second Address | Elmira, NY 14905-1629 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2006 |
Last Update Date | 25/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
04197320 | (05) | NY |