Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 197118-1 | NY |
Y | 208000000X | Pediatrician | 197118-1 | NY |
NPI | 1215136692 |
---|---|
Provider Name | Dr. Judith Ellen Shoobe |
First Address | New York, NY 10027-4402 |
Second Address | New York, NY 10035-1815 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2007 |
Last Update Date | 16/07/2007 |