Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XP3100X | Pediatric Orthopaedic Surgeon | 017874 | NY |
NPI | 1518361856 |
---|---|
Provider Name | Mrs. Rachael Elizabeth Staub |
First Address | Lake Success, NY 11042 |
Second Address | Waterbury, CT 06708-2652 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/10/2014 |
Last Update Date | 07/07/2021 |