Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 044282 | NY |
NPI | 1003946336 |
---|---|
Provider Name | Dr. Ellen J Solomon |
First Address | Middletown, NY 10940 |
Second Address | Middletown, NY 10940 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2007 |
Last Update Date | 08/07/2007 |