Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | 108707 | NY |
NPI | 1003860354 |
---|---|
Provider Name | Edmund Francis Fallon |
First Address | Glens Falls, NY 12801-0304 |
Second Address | Wilton, NY 12831-1308 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2006 |
Last Update Date | 03/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00381177 | (05) | NY |
C11769 | (02) | |
P00402828 | RR MEDICARE (01) | NY |