Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 213827 | NY |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 213827 | NY |
NPI | 1114950227 |
---|---|
Provider Name | Lawrence Kusior |
First Address | Poughkeepsie, NY 12601-6027 |
Second Address | Poughkeepsie, NY 12601-6027 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2006 |
Last Update Date | 30/09/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01955173 | (05) | NY |
F63688 | (02) | NY |