Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 309684 | NY |
NPI | 1063028041 |
---|---|
Provider Name | Alanna Baldassarre |
First Address | East Northport, NY 11731-3446 |
Second Address | East Northport, NY 11731-3446 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2020 |
Last Update Date | 16/09/2020 |