Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | 291399 | NY |
NPI | 1013910256 |
---|---|
Provider Name | Dr. Jose Maria Acostamadiedo |
First Address | Plattsburgh, NY 12901-2306 |
Second Address | Plattsburgh, NY 12901-2306 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2005 |
Last Update Date | 11/10/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H18056 | (02) | VA |