Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | F343206-1 | NY |
NPI | 1003391483 |
---|---|
Provider Name | Ann-Marie Civil |
First Address | Saint Albans, NY 11412-2014 |
Second Address | Saint Albans, NY 11412-2014 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/10/2018 |
Last Update Date | 01/10/2018 |