Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 228916 | NY |
NPI | 1073582581 |
---|---|
Provider Name | Tobi Berchen |
First Address | Geneseo, NY 14454-1090 |
Second Address | Geneseo, NY 14454-1090 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2006 |
Last Update Date | 06/08/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02431703 | (05) | NY |
F07294 | (02) | NY |