Individual
BE TY DY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
9002 QUEENS BLVD, ELMHURST, NY 11373-4941
(718) 558-1283
Mailing address
9002 QUEENS BLVD, ELMHURST, NY 11373-4941
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
132541
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00576114
—
NY
Enumeration date
03/06/2007
Last updated
05/06/2008
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