Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156F00000X | Technician/Technologist | 801967981 | NY |
NPI | 1275833121 |
---|---|
Provider Name | Lauren Sutera |
First Address | Briarwood, NY 11435-1132 |
Second Address | Briarwood, NY 11435-1132 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2010 |
Last Update Date | 26/10/2010 |