Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 003597 | NY |
NPI | 1134349111 |
---|---|
Provider Name | Dr. Barbara Ann Pelc |
First Address | Glen Head, NY 11545-1739 |
Second Address | Glen Head, NY 11545-1739 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2007 |
Last Update Date | 08/07/2007 |