Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 163632 | NY |
NPI | 1013915529 |
---|---|
Provider Name | Kalpana Modi |
First Address | Poughkeepsie, NY 12601-1363 |
Second Address | Poughkeepsie, NY 12601-1363 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2005 |
Last Update Date | 06/05/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00914778 | (05) | NY |
A63105 | (02) | NY |