Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 129980 | NY |
NPI | 1073601811 |
---|---|
Provider Name | Dr. Mark A Godecki |
First Address | Utica, NY 13502-4854 |
Second Address | Utica, NY 13502-4854 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2006 |
Last Update Date | 21/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00561582 | (05) | NY |