Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 272816 | NY |
N | 208000000X | Pediatrician | T-02774 | KS |
NPI | 1003128109 |
---|---|
Provider Name | Garry Durosier |
First Address | Albany, NY 12212-4890 |
Second Address | Troy, NY 12180-1628 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2010 |
Last Update Date | 12/05/2021 |