Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 180786 | NY |
N | 2080A0000X | Adolescent Medicine | 180786 | NY |
NPI | 1174547772 |
---|---|
Provider Name | Jane Swedler |
First Address | Mineola, NY 11501-3808 |
Second Address | Mineola, NY 11501-3808 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01358341 | (05) | NY |