Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | N006233-1 | NY |
NPI | 1023291820 |
---|---|
Provider Name | Mrs. Dora Evegenii Valdberg |
First Address | Brooklyn, NY 11204-4101 |
Second Address | Brooklyn, NY 11204-4101 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2007 |
Last Update Date | 14/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
FV0556920 | DEA (01) | NY |
N006233-1 | LICENSE (01) | NY |