Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | C15478BOCO | NY |
Y | 222Z00000X | Podiatrist | C15478BOCO | NY |
NPI | 1053604611 |
---|---|
Provider Name | James Chavez |
First Address | Lawrence, NY 11559-2904 |
Second Address | Lawrence, NY 11559-2904 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2011 |
Last Update Date | 16/05/2011 |