Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | F420999-1 | NY |
NPI | 1073813960 |
---|---|
Provider Name | Mrs. Rebecca Zack Callahan |
First Address | New York, NY 10028-0553 |
Second Address | New York, NY 10028-0553 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2010 |
Last Update Date | 01/02/2012 |