Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 087920 | NY |
Y | 207QA0505X | Family Doctor - Adult Medicine | 087920 | NY |
NPI | 1063720076 |
---|---|
Provider Name | Dr. William Seth Hallenbeck III |
First Address | Greene, NY 13778-4157 |
Second Address | Greene, NY 13778-4157 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/09/2010 |
Last Update Date | 24/09/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00627078 | (05) | NY |
C49901 | (02) | NY |