Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 63 016221 | NY |
NPI | 1023384724 |
---|---|
Provider Name | Mr. Joseph Nicholas Videtto |
First Address | Middle Village, NY 11379-1305 |
Second Address | Brooklyn, NY 11221-3111 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2012 |
Last Update Date | 27/03/2012 |