Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | 240998 | NY |
NPI | 1225173370 |
---|---|
Provider Name | Dr. Shari Diane Reitzen-Bastidas |
First Address | Brooklyn, NY 11201-5425 |
Second Address | Brooklyn, NY 11201-5425 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2007 |
Last Update Date | 05/09/2010 |