Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 208380 | NY |
Y | 111NI0900X | Internist | 208380 | NY |
N | 207RH0002X | Hospice and Palliative Medicine | 208380 | NY |
N | 208000000X | Pediatrician | 208380 | NY |
NPI | 1306894928 |
---|---|
Provider Name | Dr. John P Patti JR. |
First Address | Elma, NY 14059-9524 |
Second Address | North Tonawanda, NY 14120-1508 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2006 |
Last Update Date | 13/04/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02078435 | (05) | NY |
H17519 | (02) | NY |