Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 048825-1 | NY |
N | 1223S0112X | Oral and Maxillofacial Surgeon | 20681 | NJ |
N | 204E00000X | Oral & Maxillofacial Surgeon | 251014 | NY |
NPI | 1477624989 |
---|---|
Provider Name | Antonio L Del Valle |
First Address | New York, NY 10022-7504 |
Second Address | New York, NY 10019-5404 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2006 |
Last Update Date | 23/12/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02083594 | (05) | NY |