Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 289470 | NY |
NPI | 1730488941 |
---|---|
Provider Name | Mary K Paul |
First Address | Massapequa, NY 11758-5031 |
Second Address | Massapequa, NY 11758 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2011 |
Last Update Date | 06/07/2018 |