Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | F421115-1 | NY |
NPI | 1003238619 |
---|---|
Provider Name | Joanna M Midy |
First Address | New Hyde Park, NY 11040-1402 |
Second Address | New Hyde Park, NY 11040-1402 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2014 |
Last Update Date | 26/09/2016 |