Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | LP01728 | RI |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 286300 | NY |
NPI | 1346478518 |
---|---|
Provider Name | Stephanie Chow |
First Address | New York, NY 10087-8082 |
Second Address | New York, NY 10029-6508 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2009 |
Last Update Date | 21/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
04562938 | (05) | NY |
RES-000 | (02) | RI |