Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | 25MA04706000 | NJ |
NPI | 1396784922 |
---|---|
Provider Name | Dr. Michael Angelo D'anton III |
First Address | Tarrytown, NY 10591-5139 |
Second Address | Wayne, NJ 07470-5043 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2006 |
Last Update Date | 01/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E23753 | (02) | NJ |