Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 044466 | NY |
NPI | 1003921792 |
---|---|
Provider Name | Ms. Martina Marie Reynolds |
First Address | New York, NY 10019 |
Second Address | New York, NY 10019 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2006 |
Last Update Date | 08/07/2007 |