Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207VE0102X | Reproductive Endocrinologist | 153615 | NY |
N | 207VG0400X | Gynecologist | 153615 | NY |
NPI | 1235226697 |
---|---|
Provider Name | Ellyn Heidi Modell |
First Address | Brooklyn, NY 11229-1064 |
Second Address | Brooklyn, NY 11229-1064 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B79614 | (02) |