Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 060307 | NY |
NPI | 1043633365 |
---|---|
Provider Name | Kathleen Schultz |
First Address | Mineola, NY 11501-4351 |
Second Address | New Hyde Park, NY 11040-1402 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2014 |
Last Update Date | 31/10/2019 |