Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PP0204X | Pediatric Emergency Physician | 170824-1 | NY |
N | 208000000X | Pediatrician | 170824-1 | NY |
NPI | 1235264516 |
---|---|
Provider Name | Dr. Wendy Rapport Graae |
First Address | South Salem, NY 10590-1317 |
Second Address | Mamaroneck, NY 10543 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
170824-1 | MEDICAL LICENSE (01) | NY |