Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 198500 | NY |
NPI | 1053336263 |
---|---|
Provider Name | Michael Ficazzola |
First Address | Melville, NY 11747-3672 |
Second Address | Yonkers, NY 10701-1304 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2006 |
Last Update Date | 23/05/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01733348 | (05) | NY |
G45371 | (02) | NY |