Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1100X | Ophthalmic | ||
N | 156FX1101X | Ophthalmic Assistant |
NPI | 1760098438 |
---|---|
Provider Name | Jenny Ma |
First Address | Little Neck, NY 11362-1354 |
Second Address | Little Neck, NY 11362-1354 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/09/2020 |
Last Update Date | 18/09/2020 |