Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | 281915 | NY |
NPI | 1710927199 |
---|---|
Provider Name | Dr. Michael Witt |
First Address | Elmira, NY 14905-1629 |
Second Address | Elmira, NY 14905 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2006 |
Last Update Date | 12/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02618413 | (05) | NY |
2091763 | (05) | MA |