Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | 301819 | NY |
NPI | 1013370956 |
---|---|
Provider Name | James Richard Wyant |
First Address | Albany, NY 12208-3412 |
Second Address | Albany, NY 12208-3412 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2016 |
Last Update Date | 01/09/2020 |