Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 256632 | NY |
NPI | 1306979067 |
---|---|
Provider Name | Sara Grace Brubaker |
First Address | New York, NY 10016-6058 |
Second Address | New York, NY 10016-6058 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/03/2007 |
Last Update Date | 01/03/2021 |