Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 122538 | NY |
NPI | 1194895813 |
---|---|
Provider Name | E James Fogel JR. |
First Address | Ithaca, NY 14850-1857 |
Second Address | Ithaca, NY 14850-1857 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00371128 | (05) | NY |