Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 1293 | WA |
NPI | 1104210053 |
---|---|
Provider Name | Dr. Peter Bongiorno |
First Address | New York, NY 10001-5006 |
Second Address | New York, NY 10001-5006 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2015 |
Last Update Date | 27/03/2015 |