Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156F00000X | Technician/Technologist |
NPI | 1174102370 |
---|---|
Provider Name | Noel Im |
First Address | Hauppauge, NY 11788-3618 |
Second Address | Hauppauge, NY 11788-3618 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2021 |
Last Update Date | 05/04/2021 |