Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | 1873671 | NY |
NPI | 1336215698 |
---|---|
Provider Name | Frederick Hesse |
First Address | Hartford, CT 06150-1094 |
Second Address | Carmel, NY 10512-1921 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2006 |
Last Update Date | 08/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D80790 | (02) | NY |