Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 058527 | NY |
Y | 1223P0221X | Pediatric Dentist | 058527 | NY |
NPI | 1043635956 |
---|---|
Provider Name | Alexandra Delfiner |
First Address | Bronx, NY 10471-3513 |
Second Address | Brooklyn, NY 11220-4121 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2014 |
Last Update Date | 03/05/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
04643216 | (05) | NY |