Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | 091223 | NY |
NPI | 1104056811 |
---|---|
Provider Name | Grace Hughes |
First Address | Brooklyn, NY 11201-2170 |
Second Address | Brooklyn, NY 11201-2170 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2009 |
Last Update Date | 16/07/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
091223 | SPECIALTY NUMBER 069 (01) | NY |