Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 1453921 | NY |
NPI | 1003887654 |
---|---|
Provider Name | Max Chudy III |
First Address | Buffalo, NY 14203-1009 |
Second Address | Buffalo, NY 14203-1009 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2006 |
Last Update Date | 04/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01092979 | (05) | NY |
F91603 | (02) |