Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | X3287 | NY |
NPI | 1033254719 |
---|---|
Provider Name | Dr. Judith Kathryn Laska-Kulba |
First Address | Constantia, NY 13044-2718 |
Second Address | Constantia, NY 13044-2718 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2007 |
Last Update Date | 08/07/2007 |