Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 33-337626 | NY |
NPI | 1003272824 |
---|---|
Provider Name | Korkoh-Jah Mamiedee George |
First Address | New York, NY 10026-2746 |
Second Address | New York, NY 10026-2746 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2016 |
Last Update Date | 08/01/2016 |