Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 003978 | NY |
NPI | 1043598147 |
---|---|
Provider Name | Dr. Santo Ralph Sampino |
First Address | Armonk, NY 10504 |
Second Address | Armonk, NY 10504 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2011 |
Last Update Date | 11/04/2017 |