Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 057323 | NY |
NPI | 1134460223 |
---|---|
Provider Name | James Patrick Iovino |
First Address | Southampton, NY 11968-2251 |
Second Address | Southampton, NY 11968-2251 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2013 |
Last Update Date | 01/04/2020 |