Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 144569 | NY |
NPI | 1649389255 |
---|---|
Provider Name | Dr. Ronald M Di Camillo |
First Address | Staten Island, NY 10306-2008 |
Second Address | Staten Island, NY 10306-2008 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2006 |
Last Update Date | 08/07/2007 |