Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | N0060261 | NY |
N | 222Z00000X | Podiatrist | N0060261 | NY |
Y | 213ES0131X | Foot Surgery | 002240 | NY |
NPI | 1285651018 |
---|---|
Provider Name | Michael D Lacivita |
First Address | Williamsville, NY 14221-8235 |
Second Address | Williamsville, NY 14221-5822 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 25/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02676171 | (05) | NY |