Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XS0106X | Orthopaedic Hand Surgeon | 65200 | CT |
Y | 208200000X | Surgeon | 312386 | NY |
Y | 208600000X | Surgeon | 312386 | NY |
N | 2082S0105X | Plastic Hand Surgeon | 312386 | NY |
NPI | 1770993693 |
---|---|
Provider Name | Jared Potts |
First Address | New Hartford, NY 13413-1001 |
Second Address | New Hartford, NY 13413-1001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/04/2014 |
Last Update Date | 30/09/2021 |