Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 040122 | NY |
NPI | 1063475424 |
---|---|
Provider Name | Dr. Jeremiah D'anna |
First Address | Staten Island, NY 10312-6405 |
Second Address | Staten Island, NY 10312-6405 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U06457 | (02) | NY |