Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | X006957-1 | NY |
NPI | 1194825034 |
---|---|
Provider Name | Dr. Patricia D'imperio |
First Address | Bayville, NY 11709-1330 |
Second Address | Elmont, NY 11003-1034 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U4631 | (02) | NY |