Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | N005805 | NY |
NPI | 1235224494 |
---|---|
Provider Name | Jeffrey P Kadlecik |
First Address | Ithaca, NY 14850-1082 |
Second Address | Ithaca, NY 14850-1082 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 18/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02195908 | (05) | NY |
223797623 | TAX ID (01) | |
U85352 | (02) |