Provider Demographics
NPI:1649724410
Name:ALBIANI-GROSA, DYLLAN (EMT)
Entity type:Individual
Prefix:
First Name:DYLLAN
Middle Name:
Last Name:ALBIANI-GROSA
Suffix:
Gender:M
Credentials:EMT
Other - Prefix:MR
Other - First Name:DYLLAN
Other - Middle Name:
Other - Last Name:ALBIANI-GROSS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:EMT
Mailing Address - Street 1:5216 MARIE CT
Mailing Address - Street 2:
Mailing Address - City:NORTH TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-9593
Mailing Address - Country:US
Mailing Address - Phone:716-525-3512
Mailing Address - Fax:
Practice Address - Street 1:5216 MARIE CT
Practice Address - Street 2:
Practice Address - City:NORTH TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14120-9593
Practice Address - Country:US
Practice Address - Phone:716-525-3512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-10
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY431760146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic