Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 340908 | NY |
NPI | 1053752022 |
---|---|
Provider Name | Maria Theresa Panlilio-Ortiz |
First Address | Johnson City, NY 13790-2580 |
Second Address | Binghamton, NY 13905-3103 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2013 |
Last Update Date | 23/03/2020 |