Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 002833 | NY |
NPI | 1073516092 |
---|---|
Provider Name | Dr. Richard Anthony Belli JR. |
First Address | Woodside, NY 11377-4156 |
Second Address | Woodside, NY 11377-4156 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2005 |
Last Update Date | 26/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T31870 | (02) | NY |