Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 032133-1 | NY |
NPI | 1013009968 |
---|---|
Provider Name | Dr. Thomas J Fallon |
First Address | Liverpool, NY 13088-3807 |
Second Address | Liverpool, NY 13088-3807 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2006 |
Last Update Date | 08/07/2007 |