Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 135693 | NY |
N | 2080P0207X | Pediatric Hematology-Oncologist | 135693 | NY |
NPI | 1275590697 |
---|---|
Provider Name | Richard C Ancona |
First Address | Smithtown, NY 11787-2900 |
Second Address | Smithtown, NY 11787-2900 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B11227 | (02) | NY |