Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | N005265 | NY |
N | 222Z00000X | Podiatrist | N005265 | NY |
Y | 213ES0131X | Foot Surgery | N005265 | NY |
NPI | 1386615342 |
---|---|
Provider Name | Dr. Wendy R Young-Gomerman |
First Address | Stony Brook, NY 11790-0989 |
Second Address | Smithtown, NY 11787-2814 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2006 |
Last Update Date | 03/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U62331 | (02) | NY |