Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | 193588-1 | NY |
NPI | 1083643209 |
---|---|
Provider Name | Dr. Mencio Antonio Chez |
First Address | North Tonawanda, NY 14120-2840 |
Second Address | North Tonawanda, NY 14120-2840 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00010029601 | UNIVERA (01) | NY |
000523652002 | BLUE CROSS BLUE SHIELD (01) | NY |
01814020 | (05) | NY |
2207119 | INDEPENDENT HEALTH (01) | NY |
G01507 | (02) | NY |