Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 059772 | NY |
N | 1223G0001X | General Practice | 059772 | NY |
N | 213EG0000X | General Practice | 059772 | NY |
NPI | 1114450327 |
---|---|
Provider Name | Dr. Rita Susan O'dwyer |
First Address | Saint James, NY 11780-0143 |
Second Address | Stony Brook, NY 11790-2563 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2017 |
Last Update Date | 29/09/2020 |