Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 045286 | NY |
NPI | 1013078997 |
---|---|
Provider Name | Stan D Drabik |
First Address | Webster, NY 14580 |
Second Address | Webster, NY 14580 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02207610 | (05) | NY |
7004 | BCBS (01) |