Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | X007742 | NY |
NPI | 1649335050 |
---|---|
Provider Name | Dr. Michael C Raucci |
First Address | Walden, NY 12586-2112 |
Second Address | Walden, NY 12586-2112 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/12/2006 |
Last Update Date | 08/07/2007 |