Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 0449341 | NY |
NPI | 1073619797 |
---|---|
Provider Name | Dr. Martha A Chun |
First Address | Newburgh, NY 12550 |
Second Address | Newburgh, NY 12550 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2006 |
Last Update Date | 08/07/2007 |