Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | 1951301 | NY |
NPI | 1144296120 |
---|---|
Provider Name | Dr. Cynthia Pan |
First Address | Fresh Meadows, NY 11365-1551 |
Second Address | Fresh Meadows, NY 11365-1551 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2006 |
Last Update Date | 09/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01745422 | (05) | NY |
G22627 | (02) |