Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | POR 160 | FL |
Y | 222Z00000X | Podiatrist | POR 160 | FL |
N | 224P00000X | Prosthetist | POR 160 | FL |
NPI | 1407247240 |
---|---|
Provider Name | John Affenita |
First Address | East Patchogue, NY 11772-4869 |
Second Address | Tamarac, FL 33321-3242 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2015 |
Last Update Date | 16/03/2015 |