Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 054460 | NY |
NPI | 1053649541 |
---|---|
Provider Name | Dr. Kellie Ann Alberry |
First Address | Plainview, NY 11803-1323 |
Second Address | Plainview, NY 11803-1323 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/11/2009 |
Last Update Date | 23/11/2009 |