Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0204X | Pediatric Emergency Doctor | 244801 | NY |
NPI | 1043449150 |
---|---|
Provider Name | Kelly Cleary |
First Address | New York, NY 10016-6402 |
Second Address | New York, NY 10016-6402 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2009 |
Last Update Date | 21/08/2012 |