Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 199053 | NY |
NPI | 1003211681 |
---|---|
Provider Name | Michelle Small |
First Address | Bedford Hills, NY 10507-2410 |
Second Address | Bedford Hills, NY 10507-2418 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2014 |
Last Update Date | 25/10/2014 |