Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 194335 | NY |
Y | 208600000X | Surgeon | 194335 | NY |
NPI | 1003960881 |
---|---|
Provider Name | Dr. David Michael Monacelli |
First Address | Ithaca, NY 14850-1857 |
Second Address | Ithaca, NY 14850-1857 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01487907 | (05) | NY |
F73467 | (02) | NY |