Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 223800 | NY |
NPI | 1023084696 |
---|---|
Provider Name | Karen M Wesson |
First Address | Great Neck, NY 11021-5317 |
Second Address | Great Neck, NY 11021-5317 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/02/2006 |
Last Update Date | 16/12/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
CI8847 | RAILROAD MEDICARE (01) | NY |
I00362 | (02) | NY |