Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 176143 | NY |
N | 207KA0200X | Allergist | 176143 | NY |
NPI | 1184619298 |
---|---|
Provider Name | Amy Helen Korobow |
First Address | Huntington, NY 11743-2779 |
Second Address | Huntington, NY 11743-2779 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2005 |
Last Update Date | 04/04/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0564419 | GHI (01) | NY |
F46634 | (02) | NY |