Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 033365-1 | NY |
NPI | 1649492406 |
---|---|
Provider Name | Anthony Vernillo |
First Address | Long Island City, NY 11103-1912 |
Second Address | New York, NY 10010-4020 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2007 |
Last Update Date | 08/07/2007 |