Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 038058 | NY |
NPI | 1063672319 |
---|---|
Provider Name | Dr. Michele Bussy Chammah |
First Address | New York, NY 10065-8431 |
Second Address | New York, NY 10065-8431 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2008 |
Last Update Date | 10/06/2008 |