Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 22237 | MA |
Y | 1223E0200X | Endodontist | 055481 | NY |
NPI | 1083878771 |
---|---|
Provider Name | Dr. Tina Vani |
First Address | New York, NY 10024-5110 |
Second Address | New York, NY 10016-3892 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2008 |
Last Update Date | 25/04/2012 |