Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 158825 | NY |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | MA057780 | NJ |
NPI | 1477542389 |
---|---|
Provider Name | Jayde Steckowych |
First Address | Bronx, NY 10461-2507 |
Second Address | Bronx, NY 10453-4303 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/10/2005 |
Last Update Date | 03/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
042191 | PTAN (01) | NJ |
E86368 | (02) | NJ |