Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | X008577 | NY |
NPI | 1245362391 |
---|---|
Provider Name | Dr. Peter Thomas Gastaldi |
First Address | Staten Island, NY 10305-4660 |
Second Address | Staten Island, NY 10305-4660 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U66034 | (02) | NY |