Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 000039 | NY |
NPI | 1083003743 |
---|---|
Provider Name | Emi Shimizu |
First Address | Edison, NJ 08817-2046 |
Second Address | New Yrok, NY 10010 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2015 |
Last Update Date | 20/01/2015 |