Healthcare Provider Details

I. General information

NPI: 1912969239
Provider Name (Legal Business Name): DAVID R HOOTNICK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 07/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7449 MORGAN ROAD AVON OFFICE PARK
LIVERPOOL NY
13090-3501
US

IV. Provider business mailing address

7449 MORGAN ROAD AVON OFFICE PARK
LIVERPOOL NY
13090-3501
US

V. Phone/Fax

Practice location:
  • Phone: 315-451-5400
  • Fax: 315-451-5422
Mailing address:
  • Phone: 315-451-5400
  • Fax: 315-451-5422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number128072
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: