Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 030265 | NY |
Y | 213EG0000X | General Practice | 030265 | NY |
NPI | 1003035502 |
---|---|
Provider Name | Dr. Joseph Anthony Simonetti |
First Address | Brentwood, NY 11717-6022 |
Second Address | Brentwood, NY 11717-6022 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2007 |
Last Update Date | 08/07/2007 |