Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | DS031556L | PA |
NPI | 1073508834 |
---|---|
Provider Name | Robyn Elizabeth Weiner Ivker |
First Address | Chadds Ford, PA 19317 |
Second Address | Chadds Ford, PA 19317 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2005 |
Last Update Date | 03/05/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001962580 | (05) | PA |