Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 239931 | NY |
NPI | 1003859331 |
---|---|
Provider Name | Dr. Jama Lorynn Peacock Birsett |
First Address | Greenfield Center, NY 12833-0159 |
Second Address | Saratoga Springs, NY 12866-6044 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2006 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
239931 | NYC LICENSE (01) | NY |
BP9770303 | DEA (01) | NY |
I58531 | (02) | NY |