Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | D62011 | MD |
Y | 207VX0201X | Gynecologic Oncologist | 224188 | NY |
NPI | 1144263765 |
---|---|
Provider Name | Ginger Jean Gardner |
First Address | New York, NY 10017-6706 |
Second Address | New York, NY 10065-6007 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2006 |
Last Update Date | 19/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8RR1130601 | MEDICARE PTAN (01) | NY |
8RR11EE101 | MEDICARE PTAN (01) | NY |
I17014 | (02) | MD |