Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 209412 | NY |
NPI | 1063465987 |
---|---|
Provider Name | Marlene Corujo |
First Address | Garden City, NY 11530-2133 |
Second Address | Jamaica, NY 11432-4727 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01828202 | (05) | NY |
G70044 | (02) | NY |