Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 002468 | NY |
NPI | 1023342581 |
---|---|
Provider Name | Dr. Charles Edward Deciutiis |
First Address | Bronx, NY 10466-4309 |
Second Address | Bronx, NY 10466-4309 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2009 |
Last Update Date | 30/09/2009 |