Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | 003759-1 | NY |
NPI | 1194736496 |
---|---|
Provider Name | Mark Duane Lentini |
First Address | Albany, NY 12203-5066 |
Second Address | Albany, NY 12203-5066 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00873487 | (05) | NY |
141699003 | FEDERAL TAX ID (01) | NY |
T89594 | (02) | NY |