Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 229284 | NY |
NPI | 1053364323 |
---|---|
Provider Name | Allen Ahdoot |
First Address | Great Neck, NY 11021-5306 |
Second Address | Great Neck, NY 11021-5306 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2006 |
Last Update Date | 04/04/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5V0021 | MEDICARE (01) | NY |