Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 292962 | NY |
NPI | 1063908820 |
---|---|
Provider Name | Ivo Peto |
First Address | Manhasset, NY 11030-3816 |
Second Address | Manhasset, NY 11030-3816 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2018 |
Last Update Date | 05/07/2018 |