Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 046262 | NY |
NPI | 1144486853 |
---|---|
Provider Name | Firdous Jehan |
First Address | New York, NY 10159-1698 |
Second Address | New York, NY 10004 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2008 |
Last Update Date | 01/08/2008 |