Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 151007 | NY |
N | 208000000X | Pediatrician | 151007 | NY |
NPI | 1134147267 |
---|---|
Provider Name | Rose Marie Young |
First Address | Commack, NY 11725-2900 |
Second Address | Commack, NY 11725-2900 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 28/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A62179 | (02) |