Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | 320092 | NY |
NPI | 1407237647 |
---|---|
Provider Name | Mr. Afix Famosa |
First Address | Syracuse, NY 13210-4129 |
Second Address | Syracuse, NY 13210-4129 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2015 |
Last Update Date | 12/06/2015 |