Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | 295034 | NY |
NPI | 1861758963 |
---|---|
Provider Name | Miss Abigail Louise Mantica |
First Address | Albany, NY 12206-1048 |
Second Address | Albany, NY 12206-1069 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2012 |
Last Update Date | 02/01/2019 |