Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | NO-05998-0 | NY |
Y | 222Z00000X | Podiatrist | NO-05998-0 | NY |
N | 213ES0131X | Foot Surgery | NO-05998-0 | NY |
NPI | 1205927159 |
---|---|
Provider Name | Susan Ra Paek |
First Address | Flushing, NY 11355-1266 |
Second Address | Brooklyn, NY 11209-7104 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2006 |
Last Update Date | 21/02/2012 |