Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | F001000 | NY |
NPI | 1013055680 |
---|---|
Provider Name | Pamela Koch |
First Address | East Setauket, NY 11733-4079 |
Second Address | East Setauket, NY 11733-4079 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/02/2007 |
Last Update Date | 18/03/2010 |