Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 239077 | NY |
NPI | 1003864216 |
---|---|
Provider Name | Martha G. Aliwalas |
First Address | East Syracuse, NY 13057-9208 |
Second Address | East Syracuse, NY 13057-9208 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2006 |
Last Update Date | 05/12/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2736905 | (05) | NY |
H74998 | (02) | NY |