Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 042515 | NY |
NPI | 1003223231 |
---|---|
Provider Name | Dr. Patricia Patricia Neil |
First Address | New York, NY 10002-7537 |
Second Address | New York, NY 10002-7537 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2014 |
Last Update Date | 21/07/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
042515 | NYS LICENSE (01) | NY |