Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0004X | Dentist Anesthesiologist | 001269 | NY |
NPI | 1386123172 |
---|---|
Provider Name | Mrs. Konstantina K Sarandeva Giesberg |
First Address | New City, NY 10956-7541 |
Second Address | New Milford, NJ 07646-2128 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2018 |
Last Update Date | 13/08/2018 |