Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 190044 | NY |
Y | 207YP0228X | Pediatric Otolaryngology | 190044-1 | NY |
NPI | 1427054824 |
---|---|
Provider Name | Dr. Mark L. Nagy |
First Address | Williamsville, NY 14221 |
Second Address | Williamsville, NY 14221-6060 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2005 |
Last Update Date | 05/07/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01719364 | (05) | NY |
G43344 | (02) | NY |