Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 053106 | NY |
NPI | 1053561324 |
---|---|
Provider Name | Dr. Homa Sara Samimi |
First Address | North Babylon, NY 11703-1200 |
Second Address | North Babylon, NY 11703-1200 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2008 |
Last Update Date | 23/09/2008 |