Individual
IDY TAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1991 MARCUS AVE STE 300, NEW HYDE PARK, NY 11042-2058
(516) 719-3376
Mailing address
1991 MARCUS AVE STE 300, NEW HYDE PARK, NY 11042-2058
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
334398
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/24/2021
Last updated
03/20/2025
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