Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 028517 | NY |
NPI | 1972512812 |
---|---|
Provider Name | Dr. Robert S Kull |
First Address | Buffalo, NY 14224-3044 |
Second Address | Buffalo, NY 14224-3044 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2006 |
Last Update Date | 25/01/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4001292 | INDEPENDENT HEALTH INS (01) | NY |