Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 054140 | NY |
NPI | 1003054370 |
---|---|
Provider Name | Dr. Rachel Iospa |
First Address | Staten Island, NY 10308-3329 |
Second Address | Staten Island, NY 10308-3329 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2009 |
Last Update Date | 13/01/2015 |