Basic Information
| Provider Information | |||||||||
| NPI: | 1750392403 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TROYER | ||||||||
| FirstName: | CLAUDETTE | ||||||||
| MiddleName: | HOPE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 107 W 4TH ST | ||||||||
| Address2: | MOUNT VERNON NEIGHBORHOOD HEALTH CENTER | ||||||||
| City: | MOUNT VERNON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105504002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9146997200 | ||||||||
| FaxNumber: | 9146990837 | ||||||||
| Practice Location | |||||||||
| Address1: | 107 W 4TH ST | ||||||||
| Address2: | MOUNT VERNON NEIGHBORHOOD HEALTH CENTER | ||||||||
| City: | MOUNT VERNON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105504002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9146997200 | ||||||||
| FaxNumber: | 9146990837 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2006 | ||||||||
| LastUpdateDate: | 07/22/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | NY144499 | NY | Y | Allopathic & Osteopathic Physicians | Dermatology |
ID Information
| ID | Type | State | Issuer | Description | 00727500 | 05 | NY | MEDICAID |