Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 040977 | NY |
NPI | 1053414284 |
---|---|
Provider Name | Dr. Glen Carmine Donnarumma |
First Address | Tonawanda, NY 14150-4112 |
Second Address | Tonawanda, NY 14150-4112 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2006 |
Last Update Date | 21/02/2017 |