Provider Demographics
NPI:1912969239
Name:HOOTNICK, DAVID R (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:R
Last Name:HOOTNICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7449 MORGAN ROAD
Mailing Address - Street 2:AVON OFFICE PARK
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13090-3501
Mailing Address - Country:US
Mailing Address - Phone:315-451-5400
Mailing Address - Fax:315-451-5422
Practice Address - Street 1:7449 MORGAN ROAD
Practice Address - Street 2:AVON OFFICE PARK
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13090-3501
Practice Address - Country:US
Practice Address - Phone:315-451-5400
Practice Address - Fax:315-451-5422
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY128072207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00524534Medicaid
NYJ400041286Medicare PIN
NYDD6221Medicare PIN
NYB82127Medicare UPIN