Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 189088 | NY |
N | 2081P2900X | Pain Medicine | 189088 | NY |
NPI | 1154399111 |
---|---|
Provider Name | Ajendra S Sohal |
First Address | East Meadow, NY 11554-1859 |
Second Address | East Meadow, NY 11554-1859 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2006 |
Last Update Date | 10/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01464135 | (05) | NY |
F47862 | (02) | NY |