Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 0485191 | NY |
NPI | 1073669735 |
---|---|
Provider Name | Flora Niderman |
First Address | Brooklyn, NY 11201-5314 |
Second Address | Brooklyn, NY 11201 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2007 |
Last Update Date | 20/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02237805 | (05) | NY |