Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 206060 | NY |
Y | 208000000X | Pediatrician | 206060-1 | NY |
N | 2080A0000X | Adolescent Medicine | 206060-1 | NY |
NPI | 1023080645 |
---|---|
Provider Name | Mrs. Gloria Roetzer |
First Address | Cheektowaga, NY 14227 |
Second Address | Cheektowaga, NY 14227 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2006 |
Last Update Date | 11/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01747066 | (05) | NY |