Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | SC-002410-L | PA |
Y | 222Z00000X | Podiatrist | SC-002410-L | PA |
N | 213EP1101X | Primary Podiatric Medicine | SC-002410-L | PA |
N | 111NR0200X | Radiology | SC-002410-L | PA |
N | 213ER0200X | Radiology | SC-002410-L | PA |
N | 2081S0010X | Sports Medicine | SC-002410-L | PA |
N | 213ES0000X | Sports Medicine | SC-002410-L | PA |
N | 2081S0010X | Sports Medicine | SC002410L | PA |
N | 213ES0000X | Sports Medicine | SC002410L | PA |
N | 213ES0131X | Foot Surgery | SC-002410-L | PA |
NPI | 1891874285 |
---|---|
Provider Name | Dr. Larry J. Assalita |
First Address | State College, PA 16803-2438 |
Second Address | State College, PA 16803-2438 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2006 |
Last Update Date | 16/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000867765 | (05) | PA |
0008677650001 | (05) | PA |
T28314 | (02) |