Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 060413 | NY |
NPI | 1053844340 |
---|---|
Provider Name | Patrick Micaroni |
First Address | New Hartford, NY 13413-2328 |
Second Address | New Hartford, NY 13413 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2017 |
Last Update Date | 10/07/2019 |