Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 242283 | NY |
Y | 2080P0210X | Pediatric Nephrologist | 242283 | NY |
NPI | 1295940237 |
---|---|
Provider Name | Jessica Ann Reid-Adam |
First Address | Bronx, NY 10463-6217 |
Second Address | New York, NY 10029-6500 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2007 |
Last Update Date | 26/03/2013 |