Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 040378 | NY |
NPI | 1063471472 |
---|---|
Provider Name | Dr. Risa Cheryl Samuels |
First Address | Oakland Gardens, NY 11364-2244 |
Second Address | Oakland Gardens, NY 11364-2244 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01180501 | (05) | NY |