Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter | CO003702 | NY |
NPI | 1992718712 |
---|---|
Provider Name | Edward Fairchild |
First Address | Binghamton, NY 13901 |
Second Address | Binghamton, NY 13901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02408313 | (05) | NY |