Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 60-242078 | NY |
N | 208600000X | Surgeon | 60-242078 | NY |
N | 2086S0105X | Surgery of the Hand | 25MA08224900 | NJ |
N | 2086S0105X | Surgery of the Hand | 60-242078 | NY |
Y | 2086S0105X | Surgery of the Hand | ME 98153 | FL |
NPI | 1831255934 |
---|---|
Provider Name | Dr. Angelo Nicholas Incorvaia |
First Address | Boynton Beach, FL 33437 |
Second Address | Boynton Beach, FL 33437-3725 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/12/2006 |
Last Update Date | 05/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01367 | BLUE CROSS BLUE SHIELD (01) | FL |