Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 280178 | NY |
N | 204C00000X | Sports Medicine Doctor | 35-04-2582-P | OH |
NPI | 1972501682 |
---|---|
Provider Name | Dr. Michael L. Pryce |
First Address | Cortland, NY 13045-1206 |
Second Address | Cortland, NY 13045-1643 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2005 |
Last Update Date | 01/05/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
04236155 | (05) | NY |
0548401 | (05) | OH |
34-1522369 | FEDERAL TAX ID # (01) | OH |
34152236900 | WORKERS COMP. # (01) | OH |