Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 22DI02392800 | NJ |
N | 122300000X | Dentist | 50 054522 | NY |
NPI | 1003057589 |
---|---|
Provider Name | Jonelle Cox |
First Address | Brooklyn, NY 11234-2903 |
Second Address | Brooklyn, NY 11203-3961 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/03/2009 |
Last Update Date | 30/10/2013 |