Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 172157 | NY |
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 172157 | NY |
NPI | 1174516215 |
---|---|
Provider Name | Genevieve Sicuranza |
First Address | Mineola, NY 11501-4073 |
Second Address | Mineola, NY 11501-4073 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2005 |
Last Update Date | 01/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01246368 | (05) | NY |
E94702 | (02) |