Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 034444 | NY |
NPI | 1104035211 |
---|---|
Provider Name | Robert Pellecchia |
First Address | Pelham, NY 10803-2912 |
Second Address | Pelham, NY 10803-2912 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2007 |
Last Update Date | 11/01/2008 |