Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 024659 | NY |
NPI | 1114559630 |
---|---|
Provider Name | Monica Walia |
First Address | Plainview, NY 11803-3817 |
Second Address | Great Neck, NY 11021-5206 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2020 |
Last Update Date | 12/02/2020 |