Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207VG0400X | Gynecologist | 233124 | NY |
Y | 208800000X | Urologist | 233124 | NY |
NPI | 1063502243 |
---|---|
Provider Name | Renuka Tyagi |
First Address | New York, NY 10021-4870 |
Second Address | New York, NY 10021-4870 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2006 |
Last Update Date | 17/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I22683 | (02) |