Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 054601 | NY |
Y | 1223D0004X | Dentist Anesthesiologist | 001176 | NY |
NPI | 1417189853 |
---|---|
Provider Name | Dr. Camille Chiques |
First Address | New York, NY 10075-1652 |
Second Address | New York, NY 10075-1652 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2009 |
Last Update Date | 10/05/2017 |