Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 006682-1 | NY |
NPI | 1235179433 |
---|---|
Provider Name | Dr. Philip Thomas Dontino |
First Address | New Hartford, NY 13413-2651 |
Second Address | New Hartford, NY 13413-2651 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
CO-6682-1B | WORKERS COMP # (01) | NY |
U18651 | (02) | NY |