Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | F001016 | NY |
NPI | 1164499760 |
---|---|
Provider Name | Ivonne Dabovich |
First Address | Jamaica, NY 11418-2832 |
Second Address | Jamaica, NY 11418-2832 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2006 |
Last Update Date | 18/08/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02331322 | (05) | NY |
Q34264 | (02) | NY |