Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | 155828 | NY |
NPI | 1003970963 |
---|---|
Provider Name | Elizabeth Adele Sturm |
First Address | Commack, NY 11725-1705 |
Second Address | Commack, NY 11725-4403 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E28820 | (02) | NY |