Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 037259 | NY |
Y | 213EG0000X | General Practice | 037259 | NY |
NPI | 1003935628 |
---|---|
Provider Name | Allen Motola |
First Address | Farmingville, NY 11738-2291 |
Second Address | Farmingville, NY 11738-2291 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2007 |
Last Update Date | 08/07/2007 |