Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | C10008887 | DE |
N | 207XP3100X | Pediatric Orthopaedic Surgeon | 227564 | MA |
NPI | 1174605414 |
---|---|
Provider Name | Dr. Jennifer M Ty |
First Address | Rockland, DE 19732-0191 |
Second Address | Wilmington, DE 19803-3607 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2006 |
Last Update Date | 17/02/2012 |