Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | A 122810 | CA |
N | 208000000X | Pediatrician | MD14696 | RI |
Y | 2080P0204X | Pediatric Emergency Doctor | 289365 | NY |
N | 2080P0204X | Pediatric Emergency Doctor | MD14696 | RI |
NPI | 1295087153 |
---|---|
Provider Name | Dr. Almaz Sara Dessie |
First Address | New York, NY 10032 |
Second Address | New York, NY 10032-1559 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2012 |
Last Update Date | 29/06/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110102062A | (05) | MA |
1295087153 | (05) | RI |
U400207851 | MEDICARE NGS (01) | RI |