Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 054873 | NY |
NPI | 1013155944 |
---|---|
Provider Name | Dr. Stella Nashtatik |
First Address | Brooklyn, NY 11210-1051 |
Second Address | Brooklyn, NY 11210-6229 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2009 |
Last Update Date | 10/12/2012 |