Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 105928 | NY |
N | 207QA0401X | Family Doctor - Addiction Medicine | 105928 | NY |
NPI | 1063460061 |
---|---|
Provider Name | Dr. Norman Wetterau |
First Address | Dansville, NY 14437-0601 |
Second Address | Nunda, NY 14517-9785 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2006 |
Last Update Date | 31/07/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01282255 | (05) | NY |
B81891 | (02) | NY |