Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 036475 | NY |
NPI | 1003218421 |
---|---|
Provider Name | Dr. Susan Coven |
First Address | Great Neck, NY 11021-2222 |
Second Address | Great Neck, NY 11021-2222 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/09/2014 |
Last Update Date | 17/09/2014 |