Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | 294854 | NY |
NPI | 1053790477 |
---|---|
Provider Name | Mr. Marco Alfredo Campitelli |
First Address | Watertown, NY 13601-4099 |
Second Address | Watertown, NY 13601-4099 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2015 |
Last Update Date | 01/06/2021 |