Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 036141318 | IL |
Y | 208600000X | Surgeon | 036141318 | IL |
N | 208200000X | Surgeon | 247251 | NY |
N | 208600000X | Surgeon | 247251 | NY |
NPI | 1013185842 |
---|---|
Provider Name | Gregory Dalencourt |
First Address | New Hartford, NY 13413-1002 |
Second Address | Mount Vernon, IL 62864-6293 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2008 |
Last Update Date | 21/09/2016 |