Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 177639 | NY |
NPI | 1174574651 |
---|---|
Provider Name | Gwenn Lentine |
First Address | Staten Island, NY 10314-3909 |
Second Address | Staten Island, NY 10314-3909 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
68F931 | (02) | NY |