Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 222430 | NY |
NPI | 1013901172 |
---|---|
Provider Name | Dr. Mahalingam Sivakumar |
First Address | Bronx, NY 10457-7626 |
Second Address | Bronx, NY 10457-7626 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2005 |
Last Update Date | 21/04/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02134256 | (05) | NY |
H30030 | (02) | NY |