Individual
AGNES Q BANQUET
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
19 BRADHURST AVE, SUITE 1400, HAWTHORNE, NY 10532-2140
(914) 493-7585
(914) 594-4336
Mailing address
19 BRADHURST AVE, SUITE 1400, HAWTHORNE, NY 10532-2140
(914) 493-7585
(914) 594-4336
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
226787
NY
2080P0214X
Pediatric Pulmonology Physician
Primary
226787
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02415369
—
NY
Enumeration date
06/19/2006
Last updated
03/08/2016
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