Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | PENDING | NY |
NPI | 1023469855 |
---|---|
Provider Name | Brittany Martin Ecker |
First Address | Brooklyn, NY 11249-3929 |
Second Address | Flushing, NY 11358-1147 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2016 |
Last Update Date | 14/07/2020 |