Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 044040-2 | NY |
NPI | 1821024670 |
---|---|
Provider Name | Dr. Michael Boyczuk |
First Address | West Seneca, NY 14224-3339 |
Second Address | West Seneca, NY 14224-3339 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2006 |
Last Update Date | 14/09/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00010297701 | UNIVERA HEALTHCARE (01) | NY |
02118918 | (05) | NY |
U65486 | (02) | NY |