Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 031095 | NY |
Y | 213EG0000X | General Practice | 031095 | NY |
NPI | 1003195496 |
---|---|
Provider Name | Dr. Nicholas A Tedesco |
First Address | New York, NY 10036 |
Second Address | New York, NY 10036 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2011 |
Last Update Date | 16/08/2011 |