Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 251187 | NY |
Y | 2080P0205X | Pediatric Endocrinologist | 251187 | NY |
NPI | 1194983429 |
---|---|
Provider Name | Lesly Gracia Michel |
First Address | Far Rockaway, NY 11691-4423 |
Second Address | Far Rockaway, NY 11691-3621 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2008 |
Last Update Date | 19/09/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03404868 | (05) | NY |
251187 | LICENSE (01) | NY |