Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 013040 | NY |
NPI | 1124534797 |
---|---|
Provider Name | Dr. Patrick Violanti |
First Address | Oceanside, NY 11572-1620 |
Second Address | New York, NY 10004-2304 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2017 |
Last Update Date | 19/12/2017 |