Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 292475 | NY |
NPI | 1003202649 |
---|---|
Provider Name | Dr. Matthew Ian Barletta |
First Address | Amherst, NY 14226-5138 |
Second Address | Amherst, NY 14226-5138 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2015 |
Last Update Date | 15/03/2018 |