Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 55533 | CT |
NPI | 1033472568 |
---|---|
Provider Name | Shimrat R Notik |
First Address | Stamford, CT 06905-5513 |
Second Address | Stamford, CT 06905-5513 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2012 |
Last Update Date | 02/08/2016 |