Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 219334 | NY |
NPI | 1275617193 |
---|---|
Provider Name | Dr. Adam M Carpentieri |
First Address | Massapequa, NY 11758-4601 |
Second Address | Massapequa, NY 11758-4601 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2006 |
Last Update Date | 21/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02460204 | (05) | NY |
H54624 | (02) |