Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | 182512 | NY |
NPI | 1386703338 |
---|---|
Provider Name | Michelle Robin Yagoda |
First Address | New York, NY 10028-0401 |
Second Address | New York, NY 10028-0401 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2006 |
Last Update Date | 01/12/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
134038248 | UNITED HEALTHCARE (01) | |
G03738 | (02) | NY |