Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 259615 | NY |
N | 207VG0400X | Gynecologist | 259615 | NY |
N | 207VX0000X | Obstetrician | 259615 | NY |
NPI | 1073741351 |
---|---|
Provider Name | Ilia E. Calluzzo |
First Address | Westbury, NY 11590-5114 |
Second Address | Bayside, NY 11361-2056 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2009 |
Last Update Date | 03/12/2019 |