Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 210043 | NY |
NPI | 1407909112 |
---|---|
Provider Name | Dr. Lillie Michele Rosenthal |
First Address | New York, NY 10107-0817 |
Second Address | New York, NY 10107-0817 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
210043 | NYS LICENSE (01) | NY |