Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 175178 | NY |
NPI | 1265484091 |
---|---|
Provider Name | Dr. Roberto Marchitelli |
First Address | Bellmore, NY 11710-2222 |
Second Address | Bellmore, NY 11710-2222 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E20385 | (02) | NY |