Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 241313 | MA |
Y | 207Q00000X | Family Doctor | 311414 | NY |
NPI | 1003043209 |
---|---|
Provider Name | Marjorie Affel |
First Address | Lynn, MA 01903-0626 |
Second Address | Kingston, NY 12401-6449 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2009 |
Last Update Date | 26/07/2021 |