Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | AN-1992975-G-119 | MA |
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | 266292 | NY |
N | 207XP3100X | Pediatric Orthopaedic Surgeon | A115081 | CA |
NPI | 1760505481 |
---|---|
Provider Name | Eric Daniel Fornari |
First Address | Bronx, NY 10467-2404 |
Second Address | Bronx, NY 10467-2404 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2007 |
Last Update Date | 21/12/2012 |