Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 401734 | NY |
NPI | 1033526850 |
---|---|
Provider Name | Joseph Nicholas Depaola |
First Address | New York, NY 10017-5455 |
Second Address | New York, NY 10017-5455 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2014 |
Last Update Date | 02/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
401734 | NEW YORK STATE OFFICE OF THE PROFESSIONS (01) | NY |