Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 055857-1 | NY |
NPI | 1033494729 |
---|---|
Provider Name | Liora Benichou |
First Address | New York, NY 10022-2928 |
Second Address | New York, NY 10022-2928 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2011 |
Last Update Date | 13/10/2011 |