| NPI | 1417099136 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL J DECICCO Owner 315-787-5353 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: NY 220674) |
| Additional Taxonomies | 207YP0228X Otolaryngology, Pediatric Otolaryngology (Licence: NY 220674) |
| 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: NY 220674) | |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2007-08-22 |