Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 1904401 | NY |
Y | 2080P0207X | Pediatric Hematology-Oncologist | 1904401 | NY |
NPI | 1114976214 |
---|---|
Provider Name | Gloria Albarelli Kennedy |
First Address | Syracuse, NY 13210-2306 |
Second Address | Syracuse, NY 13210-2306 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2006 |
Last Update Date | 18/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01603401 | (05) | NY |
G46933 | (02) |