Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 293665 | NY |
N | 207SG0201X | Clinical Genetics (M.D.) | 293665 | NY |
NPI | 1023456845 |
---|---|
Provider Name | Alicia Latham |
First Address | New York, NY 10065-6007 |
Second Address | New York, NY 10065 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2013 |
Last Update Date | 23/10/2019 |