Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | X008247-1 | NY |
NPI | 1285839233 |
---|---|
Provider Name | Dr. Marc John Lamantia |
First Address | New York, NY 10038 |
Second Address | New York, NY 10038 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2007 |
Last Update Date | 24/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U64763 | (02) | NY |