Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | 007180 | NY |
NPI | 1417454562 |
---|---|
Provider Name | Gledi Peco |
First Address | Staten Island, NY 10305-3436 |
Second Address | Staten Island, NY 10305-3436 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2018 |
Last Update Date | 29/11/2021 |