Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 228252 | NY |
NPI | 1144852450 |
---|---|
Provider Name | Tonya Gilliam |
First Address | Yonkers, NY 10705-1272 |
Second Address | Bronx, NY 10455-1368 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2020 |
Last Update Date | 05/02/2020 |