Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 123706-1 | NY |
NPI | 1003304692 |
---|---|
Provider Name | Dr. Timoteo Zuno |
First Address | East Northport, NY 11731-4702 |
Second Address | East Northport, NY 11731-4702 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/04/2018 |
Last Update Date | 29/04/2018 |