Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 159888 | NY |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 159888 | NY |
NPI | 1073731949 |
---|---|
Provider Name | Joseph Peter Sacco |
First Address | Bronx, NY 10457 |
Second Address | Bronx, NY 10457 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2007 |
Last Update Date | 20/03/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01484459 | (05) | NY |
E20546 | (02) |