Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 204537-1 | NY |
NPI | 1023089141 |
---|---|
Provider Name | Maria Fodera |
First Address | Staten Island, NY 10305 |
Second Address | Staten Island, NY 10305 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/01/2006 |
Last Update Date | 14/07/2007 |