Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086X0206X | Surgical Oncologist | 232702 | NY |
NPI | 1427054568 |
---|---|
Provider Name | Vadim Gushchin |
First Address | Buffalo, NY 14263-0001 |
Second Address | Buffalo, NY 14263-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2005 |
Last Update Date | 25/02/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I11836 | (02) | NY |