Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 1503 | MA |
Y | 222Z00000X | Podiatrist | 1503 | MA |
NPI | 1043581796 |
---|---|
Provider Name | Dr. Mary Chin |
First Address | New York, NY 10002-6804 |
Second Address | New York, NY 10002-6804 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2012 |
Last Update Date | 25/01/2012 |