Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | N007014 | NY |
NPI | 1063876696 |
---|---|
Provider Name | Danielle Despres |
First Address | New York, NY 10041-0010 |
Second Address | New York, NY 10033-2411 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2016 |
Last Update Date | 21/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
N007014 | NYS LICENSE (01) | NY |