Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 1619111366 | CT |
N | 2080P0201X | Pediatric Allergist | 1619111366 | CT |
NPI | 1619111366 |
---|---|
Provider Name | Dr. Selene Bantz |
First Address | New York, NY 10007-2714 |
Second Address | New York, NY 10007-2714 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2009 |
Last Update Date | 01/07/2020 |