Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 222324 | NY |
NPI | 1013989599 |
---|---|
Provider Name | Ms. Tamara Koss |
First Address | Smithtown, NY 11787-2982 |
Second Address | Smithtown, NY 11787-2982 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2006 |
Last Update Date | 26/01/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E04041 | (02) |