Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 301286 | NY |
NPI | 1003921198 |
---|---|
Provider Name | Judith M Pine |
First Address | Westbury, NY 11590-1740 |
Second Address | Manhasset, NY 11030-3816 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2006 |
Last Update Date | 10/08/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P16997 | (02) |