Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | F350406-1 | NY |
NPI | 1346779162 |
---|---|
Provider Name | Mrs. Priya Pathadan |
First Address | Jamaica, NY 11418 |
Second Address | Jamaica, NY 11418 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2017 |
Last Update Date | 06/06/2017 |