Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 592 | CT |
NPI | 1134663339 |
---|---|
Provider Name | Dr. Nervana Gaballa |
First Address | Brooklyn, NY 11214-5408 |
Second Address | Milford, CT 06460-2636 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/12/2016 |
Last Update Date | 07/12/2016 |