Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 013561 | NY |
NPI | 1356093314 |
---|---|
Provider Name | William Imburgia |
First Address | Rochester, NY 14612-4241 |
Second Address | Rochester, NY 14621-3014 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/01/2022 |
Last Update Date | 21/01/2022 |