Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 056388 | NY |
NPI | 1003165051 |
---|---|
Provider Name | Dr. Jennifer Marie Forsythe |
First Address | New York, NY 10030-1854 |
Second Address | New York, NY 10030-1854 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2012 |
Last Update Date | 06/09/2012 |