Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | 155520 | NY |
NPI | 1205933835 |
---|---|
Provider Name | Michael Edward Foster |
First Address | Rochester, NY 14626-4122 |
Second Address | Rochester, NY 14626-4122 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/09/2006 |
Last Update Date | 28/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00841685 | (05) | NY |
J400081447 | MEDICARE GROUP J100044293 (01) | NY |