Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0402X | Child Neurologist | 246578 | NY |
N | 2084N0600X | Clinical Neurophysiologist | 246578 | NY |
NPI | 1376644591 |
---|---|
Provider Name | Emma Laureta |
First Address | Fresh Meadows, NY 11365-3505 |
Second Address | Bronx, NY 10467 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2006 |
Last Update Date | 10/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02118376 | (05) | NY |
H31904 | (02) | NY |