Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0100X | Occupational Health | X006867-1 | NY |
NPI | 1841359197 |
---|---|
Provider Name | Dr. Richard Anthony Marsillo |
First Address | Levittown, NY 11756-2941 |
Second Address | Levittown, NY 11756-2941 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U44056 | (02) | NY |
XOO6867-1 | LICENSE (01) | NY |