Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | X008106 | NY |
NPI | 1013000835 |
---|---|
Provider Name | Dr. Mary Ridge |
First Address | Mohegan Lake, NY 10547-1249 |
Second Address | Mohegan Lake, NY 10547-1249 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2006 |
Last Update Date | 20/01/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U72718 | (02) | NY |