Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 159346 | NY |
Y | 213ES0000X | Sports Medicine | 159346 | NY |
NPI | 1003818584 |
---|---|
Provider Name | Gerard P Varlotta |
First Address | Scarsdale, NY 10583-2211 |
Second Address | New York, NY 10017-9286 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2005 |
Last Update Date | 18/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
159346-6B | NYS WORKERS COMPENSATION (01) | NY |
BV2705462 | DEA (01) | NY |
E95026 | (02) | NY |