Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PS004645L | PA |
Y | 103T00000X | Psychologist | PS004645L | PA |
NPI | 1013547322 |
---|---|
Provider Name | Dr. John A Abbruzzese III |
First Address | Bethlehem, PA 18017-4038 |
Second Address | Bethlehem, PA 18017-4038 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2020 |
Last Update Date | 26/01/2020 |