Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | N004013 | NY |
NPI | 1245332782 |
---|---|
Provider Name | Dr. Vanda R. Scott-Johnston |
First Address | Jamaica, NY 11434-3854 |
Second Address | New York, NY 10030-2102 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0012137 | G.H.I. (01) | NY |
00913144 | (05) | NY |
T31752 | (02) | NY |