Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 198429 | NY |
Y | 2080P0208X | Pediatric Infectious Diseases | 198429 | NY |
NPI | 1619959582 |
---|---|
Provider Name | Jeffrey David Snedeker |
First Address | Ithaca, NY 14850-1055 |
Second Address | Ithaca, NY 14850-1055 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2005 |
Last Update Date | 18/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000910784001 | HEALTHNOW (01) | |
01545582 | (05) | NY |
161010811 | COMMERCIAL CARRIERS (01) | |
161010811 | RMSCO (01) | |
4602871 | AETNA MANAGED CHOICE (01) | |
5623 | TOTAL CARE/MANAGED CARE (01) | NY |
C86522 | (02) | NY |
V018315 | TRICARE (01) |