Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | N006440 | NY |
NPI | 1073842100 |
---|---|
Provider Name | Stephanie Famulari |
First Address | Staten Island, NY 10314-5646 |
Second Address | Staten Island, NY 10301-3915 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2009 |
Last Update Date | 27/10/2012 |