Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | 226190 | NY |
N | 208200000X | Surgeon | 226190 | NY |
N | 208600000X | Surgeon | 226190 | NY |
NPI | 1093883910 |
---|---|
Provider Name | Marcelo Facciuto |
First Address | New York, NY 10029-6500 |
Second Address | New York, NY 10029-6501 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2006 |
Last Update Date | 18/05/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02473247 | (05) | NY |
G88009 | (02) | NY |