Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | AEC2001101 | NY |
NPI | 1073128393 |
---|---|
Provider Name | Antoinette Natalie Massiah |
First Address | Brooklyn, NY 11213-2719 |
Second Address | Brooklyn, NY 11213-2719 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2020 |
Last Update Date | 14/09/2020 |