Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 187489 | NY |
N | 207Q00000X | Family Doctor | 187489 | NY |
Y | 207QA0401X | Family Doctor - Addiction Medicine | 187489 | NY |
NPI | 1497769764 |
---|---|
Provider Name | Mark Winsberg |
First Address | Rochester, NY 14617-5504 |
Second Address | Rochester, NY 14626-4122 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2006 |
Last Update Date | 28/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02509373 | (05) | NY |