Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 173590 | NY |
N | 111NI0900X | Internist | 173590 | NY |
N | 207RH0000X | Hematologist | 173590 | NY |
NPI | 1376759167 |
---|---|
Provider Name | Jacqueline R M Stevens |
First Address | New York, NY 10128-6900 |
Second Address | Brooklyn, NY 11201-5425 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01833774 | (05) | NY |
F11032 | (02) | NY |