Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 000909 | NY |
NPI | 1023297074 |
---|---|
Provider Name | Mrs. Marie F Jean |
First Address | Jamaica, NY 11432-3102 |
Second Address | Ridgewood, NY 11385-3403 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2007 |
Last Update Date | 26/10/2007 |