Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | 104650 | CA |
Y | 207K00000X | Allergist & Immunologist | 230693 | NY |
NPI | 1043402357 |
---|---|
Provider Name | Dr. Niya Wanich |
First Address | Englewood, NJ 07631 |
Second Address | Englewood, NJ 07631-2444 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2007 |
Last Update Date | 06/10/2016 |