Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 060281-1 | NY |
N | 1223D0001X | Dental Public Health | 060281-1 | NY |
NPI | 1659938397 |
---|---|
Provider Name | Ms. Fanney Pereyra |
First Address | New York, NY 10035 |
Second Address | New York, NY 10035 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2019 |
Last Update Date | 28/05/2019 |