Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 162804 | NY |
NPI | 1003805177 |
---|---|
Provider Name | Vito J Potenza |
First Address | East Syracuse, NY 13057-4505 |
Second Address | Rochester, NY 14626-4122 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2005 |
Last Update Date | 17/10/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E15566 | (02) |