Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 046623-1 | NY |
NPI | 1003586686 |
---|---|
Provider Name | Elise Fischer |
First Address | Armonk, NY 10504-1361 |
Second Address | Rye, NY 10580-2952 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2021 |
Last Update Date | 15/09/2021 |