Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0002X | Hospice and Palliative Medicine | 186961 | NY |
N | 207RH0003X | Hematology & Oncology | 186961 | NY |
NPI | 1275619694 |
---|---|
Provider Name | Lori Ann Attivissimo |
First Address | Woodbury, NY 11797-1918 |
Second Address | Woodbury, NY 11797-2901 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2006 |
Last Update Date | 06/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01635712 | (05) | NY |
G-22722 | (02) | NY |