Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174V00000X | Clinical Ethicist |
NPI | 1760956775 |
---|---|
Provider Name | Richard Poveromo |
First Address | Rocky Point, NY 11778-9331 |
Second Address | Port Jefferson, NY 11777-2119 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/01/2019 |
Last Update Date | 14/01/2019 |