Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 53215 | NY |
NPI | 1245452101 |
---|---|
Provider Name | Alexandra Raut |
First Address | Mount Kisco, NY 10549-3028 |
Second Address | Mt Kisco, NY 10549-3028 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2007 |
Last Update Date | 21/11/2012 |