Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 055912 | NY |
NPI | 1154594430 |
---|---|
Provider Name | Dr. Michele Landolt |
First Address | New York, NY 10017-6221 |
Second Address | New York, NY 10017-6221 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2008 |
Last Update Date | 05/09/2012 |