Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 168824 | NY |
NPI | 1992890271 |
---|---|
Provider Name | Joanna C Pessolano |
First Address | Newyork, NY 10310 |
Second Address | Staten Island, NY 10314-1530 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 27/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A60246 | (02) | |
W51097 | (02) |