Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0216X | Pediatric Rheumatologist | 180212-1 | NY |
NPI | 1881677763 |
---|---|
Provider Name | Dr. Lisa Florence Imundo |
First Address | New York, NY 10032-3729 |
Second Address | New York, NY 10032-3729 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/11/2005 |
Last Update Date | 24/11/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01605063 | (05) | NY |
G36394 | (02) | NY |