Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 242840 | NY |
NPI | 1053501114 |
---|---|
Provider Name | Rebecca Leigh O'malley |
First Address | Latham, NY 12110-2442 |
Second Address | Albany, NY 12208-3436 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2007 |
Last Update Date | 21/06/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03236679 | (05) | NY |