Healthcare Provider Details

I. General information

NPI: 1043431281
Provider Name (Legal Business Name): MICHAEL T JAMES ANP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 FRENCH RD SUITE 103
NEW HARTFORD NY
13413-1044
US

IV. Provider business mailing address

555 FRENCH RD SUITE 103
NEW HARTFORD NY
13413-1044
US

V. Phone/Fax

Practice location:
  • Phone: 315-735-3541
  • Fax: 315-724-3255
Mailing address:
  • Phone: 315-735-3541
  • Fax: 315-724-3255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF304594-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: