Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 235466 | NY |
Y | 2080P0204X | Pediatric Emergency Doctor | 235466 | NY |
NPI | 1174551287 |
---|---|
Provider Name | Dr. Heather O'donnell |
First Address | Bronx, NY 10461-2604 |
Second Address | Bronx, NY 10461-2604 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2006 |
Last Update Date | 11/07/2008 |