Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LC1500X | Nurse Practitioner - Community Health | F320026 | NY |
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | F401065 | NY |
NPI | 1649212697 |
---|---|
Provider Name | Dante D Mastronardi |
First Address | Binghamton, NY 13901-2756 |
Second Address | Binghamton, NY 13901-2756 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2006 |
Last Update Date | 22/06/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0320F320026 | (05) | NY |
050301000145 | FIDELIS CARE NY (01) | NY |
P27256 | (02) | NY |