Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | X011022 | NY |
NPI | 1366450496 |
---|---|
Provider Name | Dr. Scott Joseph Beres |
First Address | Corning, NY 14830-2614 |
Second Address | Corning, NY 14830-2614 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2006 |
Last Update Date | 08/07/2007 |