Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 0411611 | NY |
NPI | 1003975251 |
---|---|
Provider Name | Mrs. Nora A Blonda-Gil |
First Address | Mount Vernon, NY 10550 |
Second Address | Mount Vernon, NY 10550 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2006 |
Last Update Date | 21/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01048219 | (05) | NY |