Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 182847 | NY |
NPI | 1013996545 |
---|---|
Provider Name | Heidi S Puc |
First Address | Chittenango, NY 13037-8763 |
Second Address | Chittenango, NY 13037-8763 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2006 |
Last Update Date | 01/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01563675 | (05) | NY |