Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | 131-471 | NY |
NPI | 1639261548 |
---|---|
Provider Name | Dr. William J. Beals |
First Address | Liverpool, NY 13090-3718 |
Second Address | Liverpool, NY 13090-3718 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B81230 | (02) | NY |