Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 272764-1 | NY |
NPI | 1235496159 |
---|---|
Provider Name | Robert Trasolini |
First Address | Smithtown, NY 11787-2814 |
Second Address | Smithtown, NY 11787-2814 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2012 |
Last Update Date | 17/02/2019 |