Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 118254 | NY |
NPI | 1265549356 |
---|---|
Provider Name | Dr. Robert S Festa |
First Address | Holbrook, NY 11741-1823 |
Second Address | Holbrook, NY 11741-1823 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2006 |
Last Update Date | 28/03/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01281718 | (05) | NY |
F19110 | (02) | NY |