Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 141517 | NY |
NPI | 1003052713 |
---|---|
Provider Name | Dr. Elizabeth Anne Konecky |
First Address | Ny, NY 10024-5782 |
Second Address | New York, NY 10024-5760 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/12/2008 |
Last Update Date | 30/12/2008 |