Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 00000000 | NY |
Y | 208000000X | Pediatrician | C1-0012693 | DE |
NPI | 1003292897 |
---|---|
Provider Name | Asmaa Farag Azab |
First Address | Rockland, DE 19732-0191 |
Second Address | Seaford, DE 19973-3636 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2015 |
Last Update Date | 24/09/2020 |