Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 177183 | NY |
Y | 2080P0205X | Pediatric Endocrinologist | 177183 | NY |
NPI | 1043274939 |
---|---|
Provider Name | Elizabeth Wallach |
First Address | New York, NY 10029-6500 |
Second Address | New York, NY 10029-6500 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2006 |
Last Update Date | 26/03/2013 |