Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 226865 | NY |
NPI | 1205378221 |
---|---|
Provider Name | Mellisa Anderson |
First Address | Brooklyn, NY 11238-4952 |
Second Address | Brooklyn, NY 11238-4952 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2016 |
Last Update Date | 08/11/2016 |