Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 173458 | NY |
Y | 111NI0900X | Internist | 173458 | NY |
N | 207RG0300X | Geriatric Medicine | 173458 | NY |
NPI | 1013009190 |
---|---|
Provider Name | Dr. Jan Maby |
First Address | West Point, NY 10996-1109 |
Second Address | West Point, NY 10996-1109 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2006 |
Last Update Date | 15/08/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01750045 | (05) | NY |
E94826 | (02) |