Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 099921-2 | NY |
NPI | 1588679344 |
---|---|
Provider Name | Dr. Andre J. Codispoti |
First Address | Monroe, NY 10950-1538 |
Second Address | Monroe, NY 10950-1538 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B15576 | (02) | NY |