Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 106S00000X | Behavior Technician |
NPI | 1003387135 |
---|---|
Provider Name | Edgar Allan Bartolome |
First Address | Rochester, NY 14623-2223 |
Second Address | Rochester, NY 14623-2223 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/12/2018 |
Last Update Date | 31/10/2021 |