Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | N004315 | NY |
NPI | 1134276520 |
---|---|
Provider Name | Dr. Jane Pratt-Grippi |
First Address | Flushing, NY 11358-3928 |
Second Address | Flushing, NY 11358-3928 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/01/2007 |
Last Update Date | 01/04/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01053910 | (05) | NY |
5367710001 | DMERC (01) | NY |
P043159 | WOEKER'S COMPENSATION (01) | NY |
T92473 | (02) | NY |