Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 243465 | NY |
NPI | 1013107382 |
---|---|
Provider Name | Lara Carol Delong |
First Address | Brooklyn, NY 11230-6401 |
Second Address | Brooklyn, NY 11203 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2007 |
Last Update Date | 01/08/2007 |