Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 152581 | NY |
NPI | 1164500518 |
---|---|
Provider Name | Pichitra Dejkunchorn |
First Address | Stamford, CT 06906-2219 |
Second Address | Bronx, NY 10452-8001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2006 |
Last Update Date | 08/07/2007 |