Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | X004914-1 | NY |
NPI | 1073723904 |
---|---|
Provider Name | Dr. Michele Grace D'ermo |
First Address | New York, NY 10014-5922 |
Second Address | New York, NY 10014-5922 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2007 |
Last Update Date | 08/07/2007 |