Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 028040 | NY |
NPI | 1053700021 |
---|---|
Provider Name | Pauleen Azeem |
First Address | Melville, NY 11747-4147 |
Second Address | Riverhead, NY 11901-2613 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/01/2015 |
Last Update Date | 14/01/2015 |