Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 115654 | NY |
Y | 208600000X | Surgeon | 115654 | NY |
NPI | 1003150467 |
---|---|
Provider Name | Dr. Edward B. Sottile |
First Address | Somers, NY 10589-1983 |
Second Address | Somers, NY 10589-1983 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/11/2012 |
Last Update Date | 23/11/2012 |