Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 30179 | IA |
NPI | 1174732341 |
---|---|
Provider Name | Dr. Eleanor Lisa Reid |
First Address | New York, NY 10016-4324 |
Second Address | New York, NY 10016-4324 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2007 |
Last Update Date | 23/09/2019 |