Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251H1200X | Hand | 014350-1 | NY |
NPI | 1083258560 |
---|---|
Provider Name | Anita Dantzig |
First Address | East Setauket, NY 11733-3469 |
Second Address | East Setauket, NY 11733-3469 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/10/2019 |
Last Update Date | 29/10/2019 |