Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 044793 | NY |
NPI | 1073745931 |
---|---|
Provider Name | Dr. Mina Elahi |
First Address | New York, NY 10022-2432 |
Second Address | New York, NY 10022-2432 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2009 |
Last Update Date | 11/08/2009 |