Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 200828 | NY |
NPI | 1043205545 |
---|---|
Provider Name | Mark A Livecchi |
First Address | Rochester, NY 14626-4285 |
Second Address | Rochester, NY 14626-4285 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2005 |
Last Update Date | 21/02/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01892222 | (05) | NY |
P00884039 | MEDICARE RAILROAD (01) | NY |