Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 230138 | NY |
NPI | 1043257819 |
---|---|
Provider Name | Dr. Paolo Fedi |
First Address | Plattsburgh, NY 12901-2989 |
Second Address | Plattsburgh, NY 12901-2989 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2006 |
Last Update Date | 22/06/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02758189 | (05) | NY |
154906 | (02) | NY |