Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 163850 | NY |
NPI | 1053465344 |
---|---|
Provider Name | Gwen S Korovin |
First Address | New York, NY 10075-1811 |
Second Address | New York, NY 10075-1811 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2007 |
Last Update Date | 15/03/2012 |