Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | F350451-1 | NY |
NPI | 1356815864 |
---|---|
Provider Name | Priyanka J Pandya |
First Address | West New York, NJ 07093-4218 |
Second Address | Brooklyn, NY 11219-2916 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2019 |
Last Update Date | 26/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F350451-1 | NURSE PRACTITIONER LICENSE (01) | NY |