Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086X0206X | Surgical Oncologist | 279416 | NY |
NPI | 1033343702 |
---|---|
Provider Name | Dr. Jana Lori Deitch |
First Address | Smithtown, NY 11787-1454 |
Second Address | Smithtown, NY 11787-1454 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2009 |
Last Update Date | 19/06/2020 |