Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 050757 | NY |
NPI | 1073503504 |
---|---|
Provider Name | Dr. Farzad Sani |
First Address | Glens Falls, NY 12801-4382 |
Second Address | Glens Falls, NY 12801-4382 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000404001003 | BLUE SHIELD (01) | NY |
000404001004 | BLUE SHIELD (01) | NY |
000404001005 | BLUE SHIELD (01) | NY |
0017845 | DORAL DENTAL (01) | NY |
02410617 | (05) | NY |
10072379 | CDPHP (01) | NY |