Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | X012739-1 | NY |
N | 111NI0013X | Independent Medical Examiner | X0121739-1 | NY |
NPI | 1376053082 |
---|---|
Provider Name | Dr. Jerslin De Sousa |
First Address | Brooklyn, NY 11233-4804 |
Second Address | Brooklyn, NY 11233-4804 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/10/2017 |
Last Update Date | 30/05/2019 |