Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 402751 | NY |
NPI | 1003462375 |
---|---|
Provider Name | Jonathan Michael Fillers |
First Address | Binghamton, NY 13901-1616 |
Second Address | Cooperstown, NY 13326-1301 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2019 |
Last Update Date | 13/08/2019 |