Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | 261326 | NY |
NPI | 1083806624 |
---|---|
Provider Name | Marisa Elizabeth Desimone |
First Address | Syracuse, NY 13214-2016 |
Second Address | Syracuse, NY 13214-2016 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2007 |
Last Update Date | 23/08/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03304107 | (05) | NY |