Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 45530 | NY |
NPI | 1053524736 |
---|---|
Provider Name | Dr. Kathleen Ann Salius |
First Address | Mamaroneck, NY 10543 |
Second Address | Mamaroneck, NY 10543 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2007 |
Last Update Date | 08/07/2007 |