Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | N0061141 | NY |
Y | 222Z00000X | Podiatrist | N0061141 | NY |
NPI | 1013000405 |
---|---|
Provider Name | Dr. Mark C Gasparini |
First Address | Massapequa, NY 11758-4601 |
Second Address | Massapequa, NY 11758-4601 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2006 |
Last Update Date | 29/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02744232 | (05) | NY |
V07805 | (02) |