Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 295752 | NY |
N | 207QS0010X | Family Doctor - Sports Medicine | 295752 | NY |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 295752 | NY |
NPI | 1093127946 |
---|---|
Provider Name | Dina Elnaggar |
First Address | Indianapolis, IN 46202-5209 |
Second Address | Jefferson Valley, NY 10535 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2014 |
Last Update Date | 24/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A400205369 | MEDICARE (01) | NY |