Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 020393 | NY |
NPI | 1033537063 |
---|---|
Provider Name | Diana Macri |
First Address | Staten Island, NY 10306-1820 |
Second Address | Staten Island, NY 10306-1820 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2014 |
Last Update Date | 07/04/2014 |