Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 030731 | NY |
Y | 213EG0000X | General Practice | 030731 | NY |
NPI | 1003855156 |
---|---|
Provider Name | Louis Benjamin Colletti |
First Address | Hopewell Junction, NY 12533-6150 |
Second Address | Mahopac, NY 10541-4787 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2006 |
Last Update Date | 08/07/2007 |