Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | 277238 | NY |
NPI | 1366840787 |
---|---|
Provider Name | Ms. Jennifer Dawn Stanger |
First Address | Syracuse, NY 13210 |
Second Address | Syracuse, NY 13210 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/12/2014 |
Last Update Date | 17/12/2014 |