Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RX0202X | Medical Oncology | 139415 | NY |
NPI | 1043327620 |
---|---|
Provider Name | Michael Paul Fanucchi |
First Address | Hawthorne, NY 10523-6007 |
Second Address | Hawthorne, NY 10532-2140 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2006 |
Last Update Date | 18/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02913308 | (05) | NY |
C07218 | (02) | NY |