Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 105746 1 | NY |
Y | 208600000X | Surgeon | 105746 1 | NY |
N | 2086S0129X | Vascular Surgeon | 105746 1 | NY |
NPI | 1013918226 |
---|---|
Provider Name | Jonathan C Reynhout |
First Address | Williamsville, NY 14221-5800 |
Second Address | Williamsville, NY 14221-5800 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2005 |
Last Update Date | 17/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00600862 | (05) | NY |
B71465 | (02) |