Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | DS035665 | PA |
NPI | 1063609824 |
---|---|
Provider Name | Julia Mayzenberg |
First Address | Philadelphia, PA 19115-1008 |
Second Address | Philadelphia, PA 19115-1008 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2007 |
Last Update Date | 26/09/2007 |