Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 049384 | NY |
Y | 1223P0700X | Prosthodontist | 049384 | NY |
NPI | 1073558631 |
---|---|
Provider Name | Dr. Ashraf M Estafan |
First Address | Port Washington, NY 11050-3759 |
Second Address | Port Washington, NY 11050-3759 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2006 |
Last Update Date | 10/07/2013 |