Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 228661 | NY |
NPI | 1073509493 |
---|---|
Provider Name | Andrea Teixeira Bortot |
First Address | Brooklyn, NY 11219-2919 |
Second Address | Brooklyn, NY 11219-4636 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2005 |
Last Update Date | 08/07/2007 |