Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156F00000X | Technician/Technologist | 759792 | NY |
NPI | 1295046738 |
---|---|
Provider Name | Mrs. Ronnie Davidson |
First Address | Staten Island, NY 10314-4139 |
Second Address | Staten Island, NY 10314-4139 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2010 |
Last Update Date | 30/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
759792 | FILE NUMBER (01) | NY |