Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 243461 | NY |
N | 207VX0000X | Obstetrician | 243461 | NY |
NPI | 1013123579 |
---|---|
Provider Name | John Peter O'brien |
First Address | Liverpool, NY 13088 |
Second Address | Cazenoviz, NY 13035 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2007 |
Last Update Date | 23/01/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02889572 | (05) | NY |