Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 175L00000X | Homeopath |
NPI | 1366741571 |
---|---|
Provider Name | Mrs. Maryalyce Merritt |
First Address | Wassaic, NY 12592-2428 |
Second Address | Dover Plains, NY 12522 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2011 |
Last Update Date | 03/12/2018 |