Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RH0003X | Hematology & Oncology | 145841 | NY |
Y | 207RX0202X | Medical Oncology | 145841 | NY |
NPI | 1023070976 |
---|---|
Provider Name | Carmelo Anthony Puccio |
First Address | Hawthorne, NY 10532-0069 |
Second Address | Hawthorne, NY 10532-2140 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2006 |
Last Update Date | 14/10/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01085390 | (05) | NY |
A61043 | (02) | NY |