Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 050265 | NY |
NPI | 1043341738 |
---|---|
Provider Name | Dr. Michelle Marie Bailey |
First Address | Brooklyn, NY 11204-3908 |
Second Address | Brooklyn, NY 11204-3908 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2007 |
Last Update Date | 08/07/2007 |