Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 050462-1 | NY |
NPI | 1023319118 |
---|---|
Provider Name | Dr. Alexis Fermanis |
First Address | New York, NY 10011-1011 |
Second Address | New York, NY 10011-1011 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/11/2010 |
Last Update Date | 05/11/2010 |