Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 056147 | NY |
NPI | 1043568751 |
---|---|
Provider Name | Dr. Ghazal Mahjoubi |
First Address | New York, NY 10009 |
Second Address | Brooklyn, NY 11222 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2012 |
Last Update Date | 28/08/2012 |