Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | F350345-1 | NY |
NPI | 1023438918 |
---|---|
Provider Name | Alison Civale |
First Address | Great Neck, NY 11021-4090 |
Second Address | New Hyde Park, NY 11040-1433 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2014 |
Last Update Date | 24/04/2014 |