Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 125071169 | IL |
Y | 207N00000X | Dermatologist | 303345 | NY |
NPI | 1033572078 |
---|---|
Provider Name | Dorothy Rodenbeck Fernandez |
First Address | New York, NY 10016-8508 |
Second Address | New York, NY 10016-8508 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2016 |
Last Update Date | 08/05/2020 |