Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 001813 | NY |
NPI | 1114432994 |
---|---|
Provider Name | Tahiti Starship |
First Address | Brooklyn, NY 11206-5383 |
Second Address | Brooklyn, NY 11206-5383 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/12/2017 |
Last Update Date | 12/11/2019 |