Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 273021 | NY |
Y | 213ES0000X | Sports Medicine | 273021 | NY |
NPI | 1043500218 |
---|---|
Provider Name | Carolyn Thompson Chudy |
First Address | New York, NY 10017-6222 |
Second Address | New York, NY 10017-6222 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2011 |
Last Update Date | 08/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A400105434 | (02) |