Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NS0005X | Chiropractic Sports Physician | 38MC00489400 | NJ |
N | 111NS0005X | Chiropractic Sports Physician | AJ009411 | PA |
Y | 111NS0005X | Chiropractic Sports Physician | X007822 | NY |
NPI | 1104948553 |
---|---|
Provider Name | Dr. Vincent Notabartolo |
First Address | Staten Island, NY 10312-4312 |
Second Address | Staten Island, NY 10312-4312 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
X00961 | (02) | NY |