Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | 089706 | NY |
NPI | 1043300221 |
---|---|
Provider Name | Jessica G Davis |
First Address | New York, NY 10021-4635 |
Second Address | New York, NY 10021-4635 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2006 |
Last Update Date | 03/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01139651 | (05) | NY |
C11578 | (02) | NY |