Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0100X | Occupational Health | 0281341 | NY |
NPI | 1295268332 |
---|---|
Provider Name | Natalia Wlazlo |
First Address | Mount Kisco, NY 10549-4943 |
Second Address | Mount Kisco, NY 10549-4943 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2017 |
Last Update Date | 05/04/2017 |