Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 137400 | NY |
NPI | 1366401986 |
---|---|
Provider Name | Dr. Ellen S Gitler |
First Address | Mamaroneck, NY 10543-1036 |
Second Address | White Plains, NY 10605-2523 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
137400 | STATE LICENSE (01) | NY |
A63424 | (02) | NY |