Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0102X | Surgical Critical Care | 203772 | NY |
NPI | 1124185483 |
---|---|
Provider Name | Dr. Stephen M Dirusso |
First Address | Bronx, NY 10457 |
Second Address | Bronx, NY 10457-2545 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2007 |
Last Update Date | 04/12/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1724423 | (05) | NY |
637616 | (02) | NY |