Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 217528 | NY |
NPI | 1235115957 |
---|---|
Provider Name | Dr. Thomas E Schenk |
First Address | Buffalo, NY 14209-1603 |
Second Address | Buffalo, NY 14209-1603 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00025593701 | UNIVERA (01) | NY |
02161773 | (05) | NY |
1211228 | INDEPENDENT HEALTH ASSOC (01) | NY |