Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 060119 | NY |
NPI | 1114466786 |
---|---|
Provider Name | Jennifer Ha |
First Address | Hewlett, NY 11557-1600 |
Second Address | Hewlett, NY 11557-1600 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2017 |
Last Update Date | 02/09/2021 |