Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0106X | Orthopaedic Hand Surgeon | 299227 | NY |
NPI | 1184043366 |
---|---|
Provider Name | Jadie De Tolla |
First Address | Brooklyn, NY 11220-5350 |
Second Address | Brooklyn, NY 11220-5350 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2014 |
Last Update Date | 22/03/2021 |