Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | N005821-1 | NY |
Y | 222Z00000X | Podiatrist | N005821-1 | NY |
NPI | 1013956820 |
---|---|
Provider Name | Michael Anthony Couch JR. |
First Address | Liverpool, NY 13090-2821 |
Second Address | Liverpool, NY 13090-2821 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2006 |
Last Update Date | 25/07/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02165644 | (05) | NY |
U86468 | (02) |