Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | N005467 | NY |
Y | 222Z00000X | Podiatrist | N005467 | NY |
N | 213EP1101X | Primary Podiatric Medicine | 005467 | NY |
NPI | 1295728582 |
---|---|
Provider Name | James J Delorenzo |
First Address | Poughkeepsie, NY 12601-4936 |
Second Address | Poughkeepsie, NY 12601-4936 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2005 |
Last Update Date | 12/04/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01897896 | (05) | NY |
U71408 | (02) |