Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 266365 | NY |
Y | 2080P0208X | Pediatric Infectious Diseases | 002911 | NY |
NPI | 1487841110 |
---|---|
Provider Name | Dr. Esra Fakioglu |
First Address | Staten Island, NY 10314-3960 |
Second Address | Staten Island, NY 10314-3960 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2007 |
Last Update Date | 29/09/2016 |