Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 227034-1 | NY |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 227034-1 | NY |
NPI | 1114901220 |
---|---|
Provider Name | Dr. Michele F Iannuzzi-Sucich |
First Address | Middletown, NY 10940-6404 |
Second Address | Middletown, NY 10940-6404 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2005 |
Last Update Date | 21/06/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4142678 | MVP (01) | NY |
I36654 | (02) | NY |