Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 187577 | NY |
NPI | 1073590931 |
---|---|
Provider Name | Dr. William Rodino |
First Address | Boston, MA 02241-6173 |
Second Address | Staten Island, NY 10314-3937 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/12/2005 |
Last Update Date | 07/05/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01785822 | (05) | NY |
G53172 | (02) | NY |