Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 011997 | NY |
NPI | 1043587579 |
---|---|
Provider Name | Mrs. Jeanne M Koury |
First Address | New Windsor, NY 12553 |
Second Address | Middletown, NY 10940 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2011 |
Last Update Date | 29/11/2011 |