Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 213138 | NY |
N | 207YP0228X | Pediatric Otolaryngology | 213138 | NY |
N | 207YP0228X | Pediatric Otolaryngology | 36.152276 | IL |
N | 207YS0123X | Facial Plastic Surgeon | 213138 | NY |
N | 207YS0123X | Facial Plastic Surgeon | 36.152276 | IL |
N | 207YX0007X | Plastic Surgeon (Head & Neck) | 213138 | NY |
N | 207YX0007X | Plastic Surgeon (Head & Neck) | 36.152276 | IL |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 213138 | NY |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 36.152276 | IL |
NPI | 1689615924 |
---|---|
Provider Name | Gregory G Carnevale |
First Address | Rochester, NY 14642-0001 |
Second Address | Geneva, NY 14456-3443 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2006 |
Last Update Date | 19/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02160965 | (05) | NY |
H40149 | (02) |