Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | F339535-1 | NY |
NPI | 1003271875 |
---|---|
Provider Name | Mary Presciutti |
First Address | Bronx, NY 10463-3439 |
Second Address | New York, NY 10029 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2015 |
Last Update Date | 22/12/2015 |