Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | G74087 | CA |
Y | 207QS0010X | Family Doctor - Sports Medicine | 291887 | NY |
N | 207QS0010X | Family Doctor - Sports Medicine | G74087 | CA |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | G74087 | CA |
N | 213E00000X | Podiatrist | G74087 | CA |
N | 222Z00000X | Podiatrist | G74087 | CA |
NPI | 1215950092 |
---|---|
Provider Name | John Difiori |
First Address | New York, NY 10021-4823 |
Second Address | New York, NY 10021-4823 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2006 |
Last Update Date | 01/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G740870 | (05) | CA |
F32929 | (02) | CA |