Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 343312 | NY |
NPI | 1023594041 |
---|---|
Provider Name | Jennifer Mehling |
First Address | Galway, NY 12074-2330 |
Second Address | Johnstown, NY 12095-3213 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2018 |
Last Update Date | 12/07/2018 |