Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 174N00000X | Lactation Consultant | ||
Y | 208000000X | Pediatrician | 314151 | NY |
NPI | 1174091938 |
---|---|
Provider Name | Nidsy Mejia Roque |
First Address | Brooklyn, NY 11212-3139 |
Second Address | Brooklyn, NY 11212-3139 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2018 |
Last Update Date | 28/12/2021 |