Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 018252 | NY |
NPI | 1073801700 |
---|---|
Provider Name | Tracey Mcdonald-Pena |
First Address | Brooklyn, NY 11216-2607 |
Second Address | Brooklyn, NY 11216-2607 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2011 |
Last Update Date | 15/07/2011 |