Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0210X | Pediatric Nephrologist | 25MA07761200 | NJ |
NPI | 1194765859 |
---|---|
Provider Name | Dr. Leigh Mark Ettinger |
First Address | New Paltz, NY 12561-1116 |
Second Address | New Paltz, NY 12561-1116 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2006 |
Last Update Date | 01/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I17480 | (02) | NJ |