Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 060509 | NY |
NPI | 1104359793 |
---|---|
Provider Name | Alina Nidia O'brien |
First Address | New York, NY 10014-4963 |
Second Address | New York, NY 10013 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2017 |
Last Update Date | 01/09/2019 |