Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 170100000X | Medical Geneticist | 197559 | NY |
NPI | 1689728230 |
---|---|
Provider Name | Mrs. Tatiana Mamaeva |
First Address | New York, NY 10128-0510 |
Second Address | New York, NY 10128-0510 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F97922 | (02) | NY |
P618992 | OXFORD (01) | NY |