Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NN0400X | Neurology | X004673-1 | NY |
N | 111NN1001X | Nutrition | 1063 | SC |
NPI | 1851491500 |
---|---|
Provider Name | Dr. Timothy Paul Liszewski |
First Address | Amsterdam, NY 12010-2304 |
Second Address | Amsterdam, NY 12010-2304 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10001201 | CDPHP (01) | NY |