Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0202X | Pediatric Cardiologist | 029942 | CT |
Y | 2080P0202X | Pediatric Cardiologist | 143309 | NY |
NPI | 1124091269 |
---|---|
Provider Name | Dr. Michael Snyder |
First Address | Darien, CT 06820-5935 |
Second Address | New York, NY 10032-1559 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2006 |
Last Update Date | 11/01/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001299420 | CONNECTICUT MEDICAL ASSISTANCE MEDICAID PROGRAM (01) | CT |
00840464 | (05) | NY |
C10301 | (02) | NY |