Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 191506 | NY |
N | 207YS0123X | Facial Plastic Surgeon | 1915061 | NY |
NPI | 1063419232 |
---|---|
Provider Name | Gavin Setzen |
First Address | Albany, NY 12205-1407 |
Second Address | Albany, NY 12205-1407 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2005 |
Last Update Date | 03/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G44239 | (02) | |
P00151895 | RR MEDICARE (01) | NY |