Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 203166 | NY |
NPI | 1073535480 |
---|---|
Provider Name | John F Centonze |
First Address | Newark, NY 14513-1057 |
Second Address | Newark, NY 14513-1057 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2006 |
Last Update Date | 10/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01681649 | (05) | NY |
G32644 | (02) |