Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | NO4328 | NY |
NPI | 1407854813 |
---|---|
Provider Name | Suzi Campanaro |
First Address | Liverpool, NY 13088-4811 |
Second Address | Liverpool, NY 13088-4811 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2005 |
Last Update Date | 08/07/2007 |