Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 103908 | NY |
NPI | 1053335026 |
---|---|
Provider Name | Mr. Eric A Birken |
First Address | Canandaigua, NY 14424-1795 |
Second Address | Canandaigua, NY 14424-1795 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2006 |
Last Update Date | 22/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00456482 | (05) | NY |
B72331 | (02) |