Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213EP1101X | Primary Podiatric Medicine | 006439 | NY |
Y | 213ES0103X | Foot & Ankle Surgery | 006439 | NY |
NPI | 1558643221 |
---|---|
Provider Name | Dr. Lady Paula Jose Dejesus |
First Address | Astoria, NY 11103-5253 |
Second Address | Brooklyn, NY 11228-2342 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2011 |
Last Update Date | 19/09/2011 |