Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 216658-1 | NY |
NPI | 1154337087 |
---|---|
Provider Name | Dr. Anne E. Conrad |
First Address | Huntington, NY 11743-2924 |
Second Address | Huntington, NY 11743-2924 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2006 |
Last Update Date | 02/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01886460 | (05) | NY |
2697759 | GHI (01) | NY |
4C4524 | HEALTHNET (01) | NY |
501X41 | BLUE CROSS/ BLUE SHIELD (01) | NY |
H75118 | (02) | NY |
P2650564 | OXFORD (01) | NY |