Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 301496 | NY |
N | 207Q00000X | Family Doctor | OS015816 | PA |
Y | 207QA0401X | Family Doctor - Addiction Medicine | 301496 | NY |
NPI | 1295056281 |
---|---|
Provider Name | Jason Kirby |
First Address | Albany, NY 12212-4890 |
Second Address | Albany, NY 12208-1707 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2010 |
Last Update Date | 13/05/2021 |