Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 140894 | NY |
N | 207KA0200X | Allergist | MA054270 | NJ |
NPI | 1700825395 |
---|---|
Provider Name | Dr. Peter Logalbo |
First Address | Tarrytown, NY 10591-5139 |
Second Address | West Nyack, NY 10994-2229 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2006 |
Last Update Date | 03/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A63275 | (02) | NJ |