Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 016171 | NY |
NPI | 1003936758 |
---|---|
Provider Name | Susan Chiofolo |
First Address | Centereach, NY 11720-4431 |
Second Address | Smithtown, NY 11787-3135 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2007 |
Last Update Date | 08/07/2007 |