Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207KA0200X | Allergist | 230218 | NY |
N | 207KA0200X | Allergist | A94837 | CA |
N | 208000000X | Pediatrician | 230218 | NY |
N | 208000000X | Pediatrician | A94837 | CA |
N | 2080P0201X | Pediatric Allergist | 230218 | NY |
Y | 2080P0201X | Pediatric Allergist | A94837 | CA |
N | 2080P0214X | Pediatric Pulmonologist | 230218 | NY |
N | 2080P0214X | Pediatric Pulmonologist | A94837 | CA |
NPI | 1750580726 |
---|---|
Provider Name | Dr. Pauline Fani |
First Address | Roslyn, NY 11576-1447 |
Second Address | Roslyn, NY 11576-1447 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2007 |
Last Update Date | 11/07/2007 |