Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 256563 | NY |
N | 207ND0101X | MOHS-Micrographic Surgeon | 256563 | NY |
NPI | 1073740460 |
---|---|
Provider Name | Dr. Irene Josephine Vergilis-Kalner |
First Address | Brooklyn, NY 11235-6008 |
Second Address | Brooklyn, NY 11235-7848 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2009 |
Last Update Date | 07/05/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
256563 | LICENSE (01) | NY |