Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 25MA07373300 | NJ |
NPI | 1801842893 |
---|---|
Provider Name | Dr. Gangadhar S Sreepada |
First Address | Tarrytown, NY 10591-5139 |
Second Address | Wayne, NJ 07470 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2006 |
Last Update Date | 01/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I33100 | (02) | NJ |