Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 335844 | NY |
NPI | 1003056904 |
---|---|
Provider Name | Mrs. Loretta Goodman Salvay |
First Address | Woodridge, NY 12789-0000 |
Second Address | Monticello, NY 12701-2024 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2009 |
Last Update Date | 05/03/2009 |