Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0004X | Dentist Anesthesiologist | 060222 | NY |
NPI | 1417212937 |
---|---|
Provider Name | Dr. Jose Antonio Rivero Sutil |
First Address | Long Island City, NY 11101-4659 |
Second Address | Bronx, NY 10457-2545 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2012 |
Last Update Date | 31/01/2020 |