Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0210X | Pediatric Nephrologist | 234740 | NY |
NPI | 1871719542 |
---|---|
Provider Name | Dr. Katarina Supe-Markovina |
First Address | Stony Brook, NY 11794-8111 |
Second Address | Stony Brook, NY 11794-8111 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2007 |
Last Update Date | 04/03/2013 |