Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0201X | Gynecologic Oncologist | 194627 | NY |
NPI | 1003863945 |
---|---|
Provider Name | Mary Fatehi |
First Address | Hartford, CT 06150 |
Second Address | Brooklyn, NY 11201-6004 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2006 |
Last Update Date | 29/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01532058 | (05) | NY |
F78486 | (02) |