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Individual
NYO LWIN
Active
Individual
NYO LWIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
253768
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03125688
—
NY
Enumeration date
06/03/2008
Last updated
02/23/2021
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