Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 045835 | NY |
NPI | 1003087651 |
---|---|
Provider Name | Dr. Geraldine Petrosino |
First Address | Newburgh, NY 12550-5758 |
Second Address | Newburgh, NY 12550-5758 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2008 |
Last Update Date | 21/03/2008 |